Surgery for Groin Pain in Athletes

This policy addresses surgical evaluation and repair for sports‑related groin pain (athletic pubalgia/sports hernia and related entities) in athletes—including operative repair of muscles, tendons, nerves, or occult transversalis fascia defects—typically seen in sports such as soccer, hockey, and football. Surgery is reserved for activity‑limiting groin pain after failure of appropriate conservative management (rest/NSAIDs, supervised rehabilitation), when identifiable defects are present, and is considered experimental/investigational and not routinely covered given limited high‑quality evidence; coverage remains subject to the member’s benefit plan.

"Sports-related groin pain (athletic pubalgia / sports hernia) characterized by disabling, activity-dependent lower abdominal and groin pain not attributable to another cause"

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