MP08-12: In states were Medicaid does not cover newborn circumcision there is an increase in operative foreskin procedures and foreskin morbidity

Chung-Yon Lin*, Carlos Villanueva Del Rio, Gwen Grimsby, Phoenix, AZ

Introduction: Currently in 17 US states Medicaid does not cover newborn circumcision (NC). Previous studies have demonstrated this lack of coverage increases the number of circumcisions done in the operating room. Also, it is possible that penile abnormalities, such as penile torsion or hidden penis, could be used in states where circumcision is not covered to justify a foreskin procedure more so than in states that cover NC. The objective of this study was to compare ratios of NC, operative circumcisions (OC), other foreskin procedures (OFP) and cases of balanitis in states were Medicaid covers circumcision (CS) versus states that do not (NCS) using the Pediatric Health Information System (PHIS) database.

Methods: A retrospective review based on billing data from PHIS from 2011 to 2020 was conducted. After removing duplicate patients, proportions of Children’s Hospital state and insurance-type specific NC (CPT 54150, 54160) were calculated and compared to OC (CPT 54161) in CS versus NCS. Additionally, ratios of OFP (CPT 54300) to OC cases were compared in CS versus NCS. An equivalence test was also performed to assess the proportion (medicaid covered cases out of all the cases) of balanitis/balanoposthitis (ICD-9 607.1, ICD-10 N48.1, N47.6) in NCS versus CS.  The statistical analyses and Figure were generated with RStudio

Results: There were 124,423 circumcisions in 44 Children's Hospitals across 28 states. The ratio of OC to NC was significantly larger in NCS compared to CS (p < 0.001).  The ratio of OFP to OC was also significantly larger in NCS compared to CS (p < 0.001).  Evaluation of cases of balanitis revealed NCS had a significantly higher (p < 0.001) ratio of Medicaid covered cases to total cases (defined as the sum of Medicaid plus privately covered balanitis) when compared to CS, Figure 1.

Conclusions: Our findings add to the body of literature demonstrating that the lack of coverage of NC increases the number of foreskin procedures done in the operating room in NCS. In addition, in states without Medicaid coverage of NC there may be increased burden of disease related to the foreskin. These findings represent a need to further investigate the hidden costs of healthcare associated with Medcaid coverage of circumcision or the lack thereof.

Source of Funding: none