22-985 Extended Benefit Coverage for Newborn Circumcision
Date: 12/02/22
Medi-Cal coverage for newborn circumcision has been extended to age 30 days and younger
To align with the American Academy of Pediatrics (AAP) recommendations, an executive decision has been made to extend benefit coverage of newborn circumcisions as follows:
- The newborn age will now extend from 28 days and younger to 30 days and younger.
- A separate medical indication is not required for current procedural terminology (CPT) codes:
54150, circumcision using clamp or other device with regional dorsal penile or ring block, and
54160, circumcision surgical excision other than clamp, device, or dorsal slit; neonate.
The California Health & Wellness Plan (CHWP) 2023 Evidence of Coverage (EOC)/member handbook have been updated to include this benefit.
Well-child visits in the first 15 months
Ensure all neonates have a scheduled appointment for their next infant well-child visit. Schedule the recommended visits per the AAP age guidelines:
- Three-five days after birth
- One month, two months, four months, six months, nine months, 12 months and 15 months
Children turning 15 months of age must have six or more well-child visits to be compliant for the well-child visits in the first 30 months of life. The 15th month visit must be completed on or before the child’s 15 month birthday.
Additional information
Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.