Chapter 4
Section 5.7
Gynecomastia
Issue Date: May 18, 1994
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision:
1.0 CPT PROCEDURE CODES
19300, 19304, 19318
2.0 DESCRIPTION
2.1 Pathological
gynecomastia is an abnormal enlargement of the male mammary glands.
Some causes of pathological gynecomastia are testicular or pituitary
tumors, some syndromes of male hypogonadism, cirrhosis of the liver,
administration of estrogens for prostatic carcinoma, and therapy with
steroidal compounds.
2.2 Physiological
(pubertal) gynecomastia occurs in teenage boys, usually between
the ages of 13-15. In more than 90% of these boys, the condition
resolves within a year. Gynecomastia persisting beyond one year
is severe and is usually associated with pain in the breast from
distension and fibrous tissue stroma.
3.0 POLICY
Benefits may be cost-shared
for medically necessary medical, diagnostic, and surgical treatment.
Note: Coverage criteria for surgical
interventions may include, but is not limited to: severe gynecomastia
(enlargement has not resolved after one year); fibrous tissue stroma
exists; or breast pain.
4.0 EXCLUSION
Surgical treatment performed
purely for psychological reasons.
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