MedicaidCoverageMedium impact
22-984 Extended Benefit Coverage for Newborn Circumcision
Health Net·CA · Pediatrics, Family Medicine, Urology·Prior Authorization
We identified it
Jun 20, 2026
Summary
Medi-Cal has extended coverage for newborn circumcision from 28 days to 30 days of age, with no separate medical indication required for CPT codes 54150 and 54160. The policy also reinforces well-child visit scheduling requirements for the first 15 months of life.
Action Required
Immediately: Billing team must update system to allow circumcision billing (CPT 54150 and 54160) for newborns up to 30 days old instead of 28 days for Medi-Cal patients. Remove any prior authorization requirements for these codes. Ensure scheduling staff book all required well-child visits per AAP guidelines and track that children have 6+ visits by their 15-month birthday to maintain compliance.