Background: In 2003 Florida Medicaid discontinued coverage of routine neonatal circumcision resulting in an increase in more costly non-neonatal circumcisions. Florida Medicaid will cover a male circumcision in a child > 3 years for a defined medical indication or phimosis refractory to trial of topical steroid therapy (TST). We identified in a prior study that Florida Medicaid spent $1,345,533.90 on non-neonatal circumcisions as opposed to $171,675 if the same 763 boys were circumcised as newborns. Males with Florida Medicaid < 18 years of age with phimosis are referred to surgeons, often without prior management by the primary care provider (PCP).

Objectives: We sought to determine the potential cost savings in this population if PCPs screened patients for Medicaid requirements prior to urology referral. We assessed the costs associated with (1) patients who presented to urology with a retractable foreskin, (2) circumcision performed without meeting Medicaid guidelines and (3) patients not prescribed TST prior to urology presentation.

Methods: IRB approved retrospective chart review of all male patients > 3 to < 18 years of age at Nemours Children’s Health Orlando (NCH) evaluated for phimosis from September 2016 to September 2019. The population was stratified into 2 management groups based on if Medicaid criteria was met at presentation. Total costs based on Medicaid reimbursement rates.

Results: 81.5% of the patients did not meet Medicaid guidelines for circumcision on presentation. 6.6% had a documented failure of TST prior to initial presentation. Extraneous costs associated with referral prior to proper management equated to $126,406. Medicaid will save at least $74.86 per patient if they present with documented TST failure.

Conclusion: Further education of PCPs on current Medicaid guidelines for the evaluation and management of phimosis, as well as PCP adoption of TST, could reduce unnecessary office visits, healthcare costs, and family burden.