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New policy for athletic pubalgia effective March 5, 2013 

December 28, 2012    

A new policy for the surgical treatments of athletic pubalgia (AP) will be effective for dates of service on or after March 5, 2013.

AP is a condition associated with chronic groin pain and primarily affects professionally trained athletes. AP is most prevalent among athletes who participate in sports that require running, changes in direction, and repetitive kicking such as ice hockey, soccer, rugby, or football. AP has also been called athletic hernia, sports hernia, sportsman’s hernia, sportsman’s groin, soft groin, and Gilmore’s groin, among other names.

There are limited studies that compare the effectiveness of any particular surgical approach to conservative treatment of AP. Although some studies have suggested that an open or laparoscopic surgical approach to treat AP may provide successful outcomes, these studies are of low quality and do not appropriately compare the effectiveness of AP surgery to conservative treatment.

A lack of consensus regarding the etiology, diagnosis, and treatment of AP warrants the need for further research. Therefore, at this time, we must categorize surgical treatment for AP as experimental and investigational.

Please visit the Medical Policy section of our website to review the Notification for Medical Policy #11.14.26: Surgical Treatments of Athletic Pubalgia. If you have any questions, please contact your Network Coordinator or Hospital/ Ancillary Services Coordinator.

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