The impact of medicaid circumcision coverage on pediatric urologists' practices.

Abstract

Introduction: Routine circumcisions are covered by Medicaid in some U.S. states and not others. Data on how this coverage impacts pediatric urologists' practices is limited.

Objectives: This study aimed to compare urologists' practices regarding newborn and operative circumcisions, other penile surgeries, circumcision complication procedures, and foreskin related office visits in states with and without Medicaid coverage of newborn circumcision.

Study design: American Board of Urology (ABU) physician case logs from 2003 to 2023 of CPT codes for newborn circumcision, operative circumcision, circumcision complication procedures, and other penile surgeries were reviewed. Clinic visits for foreskin related conditions were compared using ICD codes. States without newborn circumcision coverage by Medicaid were compared to states with newborn circumcision coverage by Medicaid. States where the coverage changed during the study period were excluded. The Kruskal-Wallis Test was used to compare the median number of procedures per surgeon and clinic visits per surgeon between covered and uncovered states.

Results: No significant differences were found in the median number of newborn circumcisions, operative circumcisions, circumcision complication procedures, or other penile surgeries per urologist between states with and without Medicaid coverage of newborn circumcision. Urologists in states with Medicaid coverage of newborn circumcision reported more office visits for congenital chordee and hidden penis than states without coverage, but no other differences in clinic visits were observed for other foreskin related conditions.

Discussion: Prior studies have suggested that states without Medicaid coverage of newborn circumcision have increased numbers of circumcisions and other foreskin related procedures done in the operating room compared with states without coverage of newborn circumcision which may adversely affect the training and practice of urologists. This study found no difference in the case volume of penile surgery between states with and without coverage. The main limitation of the study is the source of the data from the ABU for which no prior reports exist of its accuracy or limitations.

Conclusions: This study suggests that Medicaid coverage of newborn circumcision does not significantly impact the practice patterns of pediatric urologists in either the operating room or clinic setting.