Circumcision - (0582)

Cigna covers surgical circumcision (CPT 54161) for males >28 days only for specified medical indications—concurrent repair of congenital penile/urethral abnormalities, recurrent/unresponsive balanitis or lichen sclerosus, penile neoplasm, paraphimosis (when reduction fails), severe/refractory phimosis, traumatic foreskin injury, recurrent UTIs, high‑grade (grade ≥3) VUR, and for sexually active males for HIV prevention—and deems all other indications (including routine circumcision of healthy boys to prevent UTI) not medically necessary. Coverage requires documentation of the listed diagnosis and supporting evidence (e.g., failed conservative therapy for phimosis/lichen sclerosus, culture‑proven recurrent UTIs [≥2 in 6 months], imaging confirming VUR grade ≥3, attempted manual reduction for paraphimosis), appropriate operative notes, and correct use of CPT 54161 or the claim will be denied.

"Circumcision in an individual older than 28 days of age (CPT 54161) is considered medically necessary when performed in conjunction with surgical repair of congenital urethral or penile abnormalities."