Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 11.03.02s


Attachment:B

Policy #:11.03.02s

Description:Tanner Staging System Criteria for Adolescents

Title:Bariatric Surgery



TANNER STAGING SYSTEM CRITERIA FOR ADOLESCENTS

The following table represents the Tanner Staging System criteria for adolescents:

Stage
Pubic Hair
Breast
Penis
Testes
I
PreadolescentPreadolescentPreadolescentPreadolescent
II
Sparse, long, lightly pigmented, downy straight hairBreast bud; breast and papilla elevated, with increased areolar diameterSlight enlargementEnlarged scrotum, pink, texture roughened
III
Increased pigmentation, more curlyEnlarged breast and areola with no contour separationIncreased lengthIncreased size
IV
Adult type, but lessAreola and papilla form secondary moundGlans enlarged, increased breadthEnlarged, darker in color
V
Adult distribution with spread to medial thighsNipple elevated, areola contour continuous with breastAdult sizeAdult size

Version Effective Date: 10/01/2019
Version Issued Date: 10/21/2019
Version Reissued Date: 01/09/2020



2017 AmeriHealth.