Commercial

Policy Attachment

Attachment to Policy #

11.03.02v

Attachment:

Policy #:

11.03.02v

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	Preadolescent	Preadolescent	Preadolescent	Preadolescent
II	Sparse, long, lightly pigmented, downy straight hair	Breast bud; breast and papilla elevated, with increased areolar diameter	Slight enlargement	Enlarged scrotum, pink, texture roughened
III	Increased pigmentation, more curly	Enlarged breast and areola with no contour separation	Increased length	Increased size
IV	Adult type, but less	Areola and papilla form secondary mound	Glans enlarged, increased breadth	Enlarged, darker in color
V	Adult distribution with spread to medial thighs	Nipple elevated, areola contour continuous with breast	Adult size	Adult size

Version Effective Date:

2/24/2025

Version Issued Date:

2/24/2025

Version Reissued Date: