Pennsylvania saw a meteoric rise in the number of adolescents receiving puberty blockers through an insurance billing code currently being investigated under the Trump administration on fraud suspicions.
More than 220 claims for puberty blocking drugs were reimbursed for minors aged 10-13 with the International Classification of Diseases (ICD) billing code, E30.1, for precocious puberty between Jan. 1, 2013 and Dec. 31, 2024, costing taxpayers more than $1.8 million, according to the data. The number of claims in the 10-13 age group went from zero in 2012 and ballooned to 47 by 2016. The Department of Justice (DOJ) has raised concerns that this billing code may have been fraudulently used by gender doctors to obtain insurance coverage for sex-rejecting interventions.
“A spike of this magnitude in the diagnosis of precocious puberty — especially among children past the usual age — is highly atypical and raises the very real possibility that the diagnosis has been used as a billing workaround,” Dr. Kurt Miceli, medical director at Do No Harm, told the Daily Caller News Foundation.
“The data indicates that the Department of Justice’s concerns merit serious investigation rather than being stalled in litigation,” Miceli stated.
Central Precocious Puberty (CPP) is caused by an early activation of the pituitary gland, which stimulates the production of sex hormones, and is widely accepted as occurring before age 10. ICD codes are published by the World Health Organization and provide diagnoses for diseases and injuries.
“I would expect to see kids on puberty blockers for precocious puberty if they are age 8 and younger,” Dr. Roy Eappen, an endocrinologist and Senior Do No Harm Fellow, told the DCNF.
“I would be surprised to see girls or boys on puberty blockers for precocious puberty after age 8,” Eappen stated.
A graph based on data provided to the DCNF by the PA Department of Human Services. For years 2013, 2015, 2022 and 2023, the total number of encounters was less than 11 which is represented by the number 5 on the graph.
Dr. Quentin Van Meter, a pediatric endocrinologist and past president of the American College of Pediatricians, told the DCNF it would be “very, very rare” for a child to be diagnosed with precocious puberty at age 10.
“The kids who are started on puberty blockers at age 11 and later are not generally treated for the diagnosis of precocious puberty, but are more than likely trans kids who are purposely being mis-coded to hide this travesty,” Van Meter told the DCNF.
“[The age] would be an indication that this is not precocious puberty. You’re basically trying to block true puberty, which you shouldn’t do,” Van Meter said.
Van Meter noted the data the DCNF obtained would be more meaningful if it showed the ages a child was diagnosed with precocious puberty and started on blockers. The DCNF asked for the age affiliated with each individual reimbursement claim but was not provided that information.
The data showed a more than 2100% increase in reimbursement for puberty blocker claims using the E30.1 code between 2013 to 2017, with yearly totals for minors under 18 rising from $34,906 in 2013 to $786,728 in 2017, according to data from the Pennsylvania Department of Human Services (PA DHS). There was no reimbursement for puberty blockers using this code in any age group from 2010 to 2012, according to the data.
PA DHS didn’t respond to a request for comment.
Eappen told the DCNF it seemed “highly unusual” to see such a sudden spike in the use of a specific diagnostic code for an endocrine disorder and this scenario would be more likely seen in an infectious disease.
Graph showing annual reimbursement paid by Pennsylvania for puberty blockers for minors under 18 using the billing code for precocious puberty. Data Source: Pennsylvania Department of Human Services
An additional data set was obtained by the DCNF that provided all Pennsylvania Medical Assistance spending on the puberty blocking medications Goserelin, Histrelin, Leuprolide and Triptorelin, for minors 18 and under between Jan. 1, 2020, to Dec. 31, 2024. The data set showed the state spent more than $76 million giving the drugs to minors 18 and under with the average cost per claim being over $11,200. It also revealed more than 1,000 puberty blocker claims for minors aged 14 to 18 and more than 1900 claims for those aged 10 to 13.
The DCNF requested the ICD codes affiliated with each encounter but was not provided that information.
Judges Block Transparency As DOJ Investigates Possible Medical Fraud
The DOJ is actively investigating possible billing fraud involving puberty blockers in Pennsylvania and a handful of other states, stating in an October 2025 court filing that initiating puberty blockers at age 10 and up under the diagnosis of precocious puberty raises suspicions of fraud.
More than 20 providers of child sex-rejecting procedures were subpoenaed in June 2025, including The Children’s Hospital of Philadelphia (CHOP) and Boston Children’s Hospital (BCH), as part of the DOJ’s investigation.
An analysis of insurance claims appeared to show almost 250 minors at CHOP were diagnosed with Central Precocious Puberty (CPP) at age 10 or older, including teenagers aged 14 to 18, between 2017 and 2024, an October 2025 DOJ court filing states.
“This is well beyond the age at which children are typically diagnosed with precocious puberty,” the court filing states.
Puberty blockers, which are approved by the Food and Drug Administration for the treatment of precocious puberty but not for the treatment of gender dysphoria, can cost tens of thousands of dollars.
“That’s something that if insurance doesn’t cover it, almost nobody can afford,” Nadia Dowshen, co-founder and co-medical director of the CHOP Gender Clinic, stated during a 2018 National Institutes of Health lecture.
In July 2025, CHOP filed a motion to limit the DOJ’s subpoena claiming it violated the privacy rights of patients. The DOJ said the patient information requested in the subpoena was needed to determine if the gender clinic had used improper billing codes with fraudulent intent, in a court document.
“Linking each patient’s clinical record to corresponding billing and insurance claims can demonstrate whether diagnoses were miscoded, which can prove fraudulent intent,” stated the DOJ in a court filing.
Van Meter told the DCNF you’d expect a minor with precocious puberty to have clinical documentation of early pubertal development in their medical record.
“There is going to be some lab work that will be done and there will certainly be in the medical record evidence that the child is way ahead in terms of pubertal staging,” Van Meter told the DCNF.
We offer our heartfelt congratulations to @SecretaryLevine on her nomination by @POTUS to serve as assistant secretary of the U.S. Department of Health and Human Services, @HHSGov. Dr. Levine is a true champion for children and youth, and a friend to CHOP. Photo pre-COVID-19. pic.twitter.com/hjmruzVikF
— Children’s Hospital (@ChildrensPhila) January 22, 2021
In November 2025, an Obama-appointed federal judge struck down part of the DOJ’s subpoena, writing in his memorandum opinion that providing child sex-rejection procedures aligns with Pennsylvania’s standards of medical care.
Gov. Josh Shapiro filed an amicus brief filed in support of the CHOP gender clinic that accused the DOJ of seeking “to intimidate medical providers from offering critical, medically necessary health care.”
CHOP did not respond to the DCNF’s request for comment.
BCH was also subpoenaed by the DOJ and had a “large spike” in “facially suspect diagnoses” of CPP in children aged 10 or older, similar to CHOP’s, from 2020 to 2023 which raised suspicion that children may have been given the diagnosis “to mislead insurance companies or others into covering puberty blockers for older children with gender dysphoria,” according to a court document submitted by the DOJ.
There is “no clear explanation for why BCH would go from diagnosing almost no 11-year-olds with CPP for the years 2017-19 to diagnosing 50 11-year-old patients with CPP in 2022,” the government argued. BCH’s motion to quash the DOJ subpoena was granted by a Biden-appointed federal judge.
The DOJ declined to provide the DCNF with a comment on its investigation.
Texas Attorney General Ken Paxton alleged a Texas pediatric gender doctor used a fraudulent billing code when prescribing a minor a puberty blocker in a November 2024 lawsuit. Paxton announced new evidence of fraud involving Medicaid reimbursement for sex-rejecting interventions had emerged that included “falsifying records, altering diagnosis codes, and submitting deceptive billing information,” in a December 2025 press release.
“My office has identified schemes where providers use deceptive billing codes and misdiagnoses to obscure the true nature of these despicable and legally prohibited procedures,” Paxton told the DCNF.
“I’m committed to protecting Texas children and relentlessly enforcing state law, which is why we are actively investigating fraudulent billing practices and false diagnoses used to circumvent our laws which prohibit ‘transition’ procedures on minors,” Paxton said.
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