Differential Insurance Plan Coverage and Surgeon Reimbursement of Pediatric Circumcision at an Urban, Midwestern Hospital.
Urology
; 179: 143-150, 2023 Sep.
Article
en En
| MEDLINE
| ID: mdl-37343682
ABSTRACT
OBJECTIVE:
To explore private vs public pediatric circumcision insurance coverage and surgeon reimbursement.METHODS:
A telephone survey about circumcision coverage (Current Procedural Terminology codes 54150, 54161) was conducted in October 2021 with insurance plan representatives from the 12 plans that comprised ≥1% of institutional pediatric urology visits to compare plan characteristics and coverage details. Circumcision billing data were collected at one pediatric hospital to assess surgeon reimbursement (insurance+patient payment) by plan type using bivariate statistics.RESULTS:
Ten plans (5 private and 5 public) responded (83.3% response rate). All except one public plan covered newborn circumcision. For non-newborn circumcisions, most public plans (80%) had unrestricted coverage, whereas all private plans required medical necessity. Median reimbursement for newborn circumcision (CPT 54150) was $484 for private and $78 for public plans, Pâ¯<â¯.001 while median reimbursement for non-newborn circumcision (CPT 54161) was $314 for private and $147 for public plans, Pâ¯<â¯.001.CONCLUSION:
Private insurance plans reimburse significantly more than public plans for newborn circumcision. For non-newborn circumcision, private plans reimburse more than public but the coverage is more restricted, with a smaller differential between newborn and non-newborn circumcision. This coverage and reimbursement structure may indirectly encourage newborn circumcision for privately insured boys and non-newborn circumcision for publicly insured boys.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Circuncisión Masculina
/
Cirujanos
Límite:
Child
/
Humans
/
Male
/
Newborn
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Urology
Año:
2023
Tipo del documento:
Article
País de afiliación:
Israel