MedicaidCoverageMedium impact
22-983 Extended Benefit Coverage for Newborn Circumcision
Health Net·CA · Pediatrics, Family Medicine, Urology·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health has extended Medi-Cal coverage for newborn circumcision from 28 days to 30 days of age, aligning with AAP recommendations. CPT codes 54150 and 54160 for newborn circumcision no longer require separate medical indication for infants 30 days and younger.
Action Required
Immediately: Billing team must update system parameters to allow coverage for CPT codes 54150 and 54160 for newborns up to 30 days of age (previously 28 days) for Medi-Cal patients in Fresno, Kings, and Madera counties. No separate medical indication documentation is required for these procedures within the extended age range.