TRICARE Circumcision Coverage

Well-child care for newborns includes the routine care of the newborn in the hospital, newborn circumcision and newborn screening as recommended by the American Academy of Pediatrics (AAP). Covered newborn screenings include, but are not limited to, testing for hypothyroidism, phenylketonuria (PKU) hemoglobinopathies, and galactosemia (refer to TRICARE Policy Manual,Chapter 7, Section 2.5, paragraph IV.G.2. for further details).

Only routine well-child care for newborns is covered as part of the mother’s maternity episode, i.e., a separate cost-share is not required for the infant. In most cases, if a circumcision is performed after the child has been discharged from the hospital, the service is cost-shared as an outpatient service (unless it qualifies for the special cost-sharing for ambulatory surgery and the procedure is done at a hospital or free-standing ambulatory surgery center). Separate professional claims must be submitted for the newborn and the mother for services provided after discharge.

For information on circumcisions, please refer to TRICARE Policy Manual,Chapter 7, Section 2.5 at www.tricare.mil.