CG-SURG-103 Penile Circumcision

This policy addresses penile circumcision. It is covered as medically necessary for any of the following: preputial neoplasms; recurrent balanitis or balanoposthitis; symptomatic phimosis; paraphimosis; tears of the frenulum; traumatic foreskin injury requiring surgical treatment; or risk reduction in individuals at high risk for HIV infection. Circumcision is not medically necessary when these criteria are not met; elective newborn circumcision is outside the scope of this guideline.

"Penile circumcision is consideredmedically necessarywhen the individual hasanyof the following conditions:Preputial neoplasms;orRecurrent balanitis;orRecurrent balanoposthitis;orRisk reduction for ..."

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