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At least 2 licensed mental health professionals have diagnosed gender dysphoria, and recommend surgical intervention Note: only 1 mental health professional referral is required for mastectomy ; and. Documentation of continuous hormonal therapy for at least 12 months, unless there is a documented contraindication to hormonal therapy Notes: hormonal therapy is not required prior to mastectomy; hormonal therapy for at least 6 months is required for endometrial ablation ; and.

Any of the following procedures may be considered medically necessary when clinical information is submitted expressly documenting that the intervention would improve otherwise documented significant gender dysphoria, and all of Criteria II.

Breast augmentation The individual being considered for surgery and related services must meet ALL the following criteria. The individual must have:. Psychotherapy is not required for gender reassignment services except when a mental health professional recommends psychotherapy based on initial assessment prior to gender reassignment surgery. The individual must have :.

Male-to-Female MtF surgical procedures performed as part of gender reassignment services for an individual who has met the above criteria for gender dysphoria may be considered medically necessary and include the following:.

Policy Title: Gender Reassignment Surgery. Gender affirmation surgery may be considered medically necessary when ALL of the following are met:. Note : Although not a requirement, it is recommended that individuals undergo feminizing hormone therapy minimum 12 months prior to breast augmentation surgery. Breast Augmentation Note: augmentation mammoplasty including breast prosthesis if necessary if the physician prescribing hormones and the surgeon have documented that breast enlargement after undergoing hormone treatment for 12 months is not sufficient for comfort in the social role.

Policy Title: Transgender Services Benefits. Any further intervention by surgical means would be reviewed for medical necessity in accordance with medical policy Reconstructive versus Cosmetic Surgery.

Policy Title: Gender Affirmation Surgery. Member has the capacity to make a fully informed decision and to consent for treatment. Documentation of 12 continuous months of hormone therapy unless the member has a medical contraindication or is otherwise unable to take hormones ; AND G. One referral letter from a licensed mental health professional.

Nipple reconstruction, including tattooing, following a gender affirming mastectomy that meets the reconstructive criteria above is considered reconstructive. Policy Title: Gender Affirmation Surgeries. Gender affirming surgical interventions for gender dysphoria may be considered medically necessary when both of the following criteria are met A - B :.

One or more of the following criteria are met: Clinical documentation is submitted expressly documenting that the intervention would improve otherwise documented significant gender dysphoria and the request is for one or more of the following procedures: Breast augmentation.

Policy Issued By: California. Additional surgeries may be proposed i. Including, but not limited to, the following surgical procedures need to be reviewed for medical necessity see documentation needed for medical necessity determination in the Policy Guidelines section :. The individual participates in trans-gender counseling and meets all of the following:. When ALL of the above criteria are met for gender reassignment surgery, the following genital surgeries may be considered medically necessary for transwomen male to female :.

The gender reassignment surgeries that may be performed for transwomen male to female that meet the above 5 criteria include but are not limited to Mammoplasty: breast augmentation. Policy Issued By: CareSource. The following are requirements that apply for consideration of sexual reassignment surgery: List is not meant to represent all requirements.

Unless contraindicated or is unable to take, individual has participated in 12 consecutive months of cross-sex hormone therapy for the desired gender. Policy Issued By: Cigna. The procedures listed below are considered medically necessary under standard benefit plan language when the above listed criteria for gender reassignment surgery have been met, unless specifically excluded in the benefit plan language Initial breast reconstruction including augmentation with implants.

Note: Only one letter is required for breast surgery. One letter must be from a psychiatrist, psychologist, psychiatric nurse practitioner NP or licensed clinical social worker CSW with whom the member has an established and ongoing relationship. The other letter may be from a psychiatrist, psychologist, physician, psychiatric NP or licensed CSW who has only an evaluative role with the member.

Breast augmentation is considered medically necessary provided that the member has completed a minimum of 24 months of hormone therapy, during which time breast growth has been negligible; or hormone therapy is medically contraindicated; or the member is otherwise unable to take hormones. The patient has received a recommendation letter from a qualified mental health professional refer to Policy Guidelines below ; and.

The patient has been diagnosed with persistent gender dysphoria, including all of the following:. The patient has reached the age of majority 18 years of age or older ; and. If significant medical or mental health concerns are present, they must be reasonably well controlled; and. The patient has completed a minimum of 24 months of hormone therapy, unless hormone therapy is medically contraindicated, or the patient is otherwise unable to take hormones.

Policy Issued By: Fallon Health. Policy Title: Gender Affirmation Services. This specific criteria applies to mastectomies for Female to Male, breast augmentations for Male to Female, and all genital surgeries.

Fallon Health may authorize the coverage of transgender surgery procedures when all of the following criteria are met, the request must be supported by the treating provider s medical records:. Surgical treatment of gender dysphoria may be considered medically necessary when all of the criteria listed below are met:. The individual is diagnosed as having a gender identity disorder GID , including a diagnosis of transsexualism that includes ALL of the following criteria:.

Recommendation letter from qualified mental health professional supporting decision for augmentation mammoplasty AND. Policy Issued By: Gateway Health. Policy Title: Gender Transition Services. The following gender confirmation surgeries are eligible services when all of the above criteria are met:. Gender confirming services may be considered medically necessary when supporting documentation is provided by the clinicians physicians and mental health professionals confirms ALL of the following:.

Policy Title: Transgender Health Services. Policy Issued By: Health Net. Capacity to make a fully informed decision and to consent for treatment;.

If significant medical or mental health concerns are present, they must be reasonably well controlled;.

Written referral letter s from a qualified mental health practitioner See below for qualifications based on the type of surgery one referral for chest surgery; two referrals for genital surgery and containing the following:. A statement about the fact that informed consent has been obtained from the patient;. A statement that the mental health professional is available for coordination of care and welcomes a phone call to establish this.

The degree to which the member has followed the standards of care to date and the likelihood of future compliance. Note: Although not an explicit criterion, it is recommended that male to female individuals undergo feminizing hormone therapy minimum 12 months prior to breast augmentation surgery. It is the policy of Health Net of California that each of the following procedures, when used specifically to improve the appearance of an individual undergoing gender reassignment surgery or actively participating in a documented gender reassignment surgery treatment plan, must be evaluated to determine if it is medically necessary reconstructive surgery to create a normal appearance for the gender with which the member identifies.

Prior to making a clinical determination of coverage, it may be necessary to consult with a qualified and licensed mental health professional and the treating surgeon. Breast augmentation. Policy Issued By: HealthPartners. Please note: Hormone therapy is not a prerequisite to mastectomy or breast augmentation. Two 2 separate letters or one 1 letter with two 2 signatures is acceptable. Policy Title: Gender Reassignment Services. Mastectomy and creation of a male chest may be considered medically necessary as part of female to male gender affirmation when all of the following criteria are met:.

One letter of referral letter of medical necessity from a licensed mental health professional, AND. Capacity to make fully informed decisions and consent for treatment, AND;.

If significant medical or mental health issues present, they must be sufficiently reasonably well controlled. Breast size measures less than Tanner stage 5 after undergoing 12 months of hormone therapy, AND.

Breast size continues to cause clinically significant distress in social, occupational, or other areas of functioning as documented by a qualified mental health provider as identified in section. Age 18 years or older Note: age requirement will not be applied to augmentation in Male-to-Female patients if the surgeon, the primary care provider, and the qualified mental health professional unanimously document the medical necessity of earlier intervention.

If significant medical or mental health concerns are present, they must be reasonably well controlled. Twelve months of living in a gender role that is congruent with their gender identity real life experience and.

The three providers must submit written documentation to the plan that includes:. A comprehensive, coordinated treatment plan with evidence that all treatment plan criteria for surgery and treatment goals have been met; and. Patient understands the treatment plan, risks and benefits of surgery prior to completing the 12month period; and. The plan will determine authorization and consent to care based on medical necessity from the documentation outlined in A-G above.

The criteria above apply for only initial male to female augmentation mammaplasty, any additional breast augmentation after an initial mammaplasty is considered a cosmetic procedure, and therefore, a contract exclusion.

Policy Title: Transgender Surgery. MtF members are eligible for Breast Augmentation if they meet all of the following criteria:. Patient understands the treatment plan, risks and benefits of surgery prior to completing the month period. The plan will determine authorization and consent to care based on medical necessity from the documentation outlined in above. Documentation from surgeon of current cup size and proposed changes as well as photo documentation.

Policy Issued By: LifeWise. One recommendation letter within the last six months from a licensed mental health professional. Documentation from the surgeon that there are no medical contraindications to surgery. Services for gender affirmation most often include Policy Issued By: Medi-Cal. Nationally recognized medical experts in the field of transgender health care have identified the following core services in treating gender dysphoria:.

Medical necessity is assessed and services shall be recommended by treating licensed mental health professionals and physicians and surgeons experienced in treating patients with gender dysphoria.

Reconstructive surgery to create a normal appearance for transgender recipients is determined to be medically necessary for the treatment of gender dysphoria on a case-by-case basis. A service or the frequency of services available to a transgender recipient cannot be categorically limited.

Be sure to consult with your physician. Patients should discuss all available treatment options and their risks and benefits with their physician. Health conditions which hamper sexual activity, such as severe chest pain angina , may prevent successful use of this device.

The prosthesis should not be implanted in patients who lack the manual dexterity or strength necessary to operate the device. Trauma to the pelvic or abdominal areas, such as impact injuries associated with sports e. This damage may result in the malfunction of the device and may necessitate surgical correction, including replacement of the device. This treatment is prescribed by your physician.

Discuss the treatment options with your physician to understand the risks and benefits of the various options to determine if a penile implant is right for you. Caution: Federal law USA restricts this device to sale by or on the order of a physician.

State Medicaid or Medicaid Managed Care. If there is coverage, procedures still must be determined medically necessary. Medicaid plans will usually require authorization for these procedures. Here are some guidelines to help you know what to expect: Penile prostheses Titan or Genesis are covered by Medicaid programs in a little over half of the states.

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Changes in healthcare ob gyn A service or the frequency of services available to a transgender recipient cannot be categorically limited. Policy Title: Gender-Affirming Procedures. Surgical treatment of gender dysphoria may be considered medically necessary when all of the criteria listed below are met:. Twelve months of living in a gender role that is congruent with their gender identity real life experience and. Patient has reached the legal age to give medical consent under applicable state kochi hr conduent and D.
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Caresource marketplace penile implant In addition to the Eligibility Qualifications listed above note click following:. Payment for cross-sex hormones for patients under 16 years of age who otherwise meet the requirements stated in Policy Statement I. Caution: Federal law USA restricts this device to sale by or on the order of a physician. Demonstrates knowledge and understanding of the expected outcomes of treatment with pubertal suppressants and cross-sex hormones, as well as the medical and social risks and benefits of sex reassignment. Documentation of breast size after 12 months of hormone therapy for MtF if applicable. MRI quality may be compromised if the area of interest is in the exact same area or relatively close to the imllant of the Titan, and Titan Touch IPP. Policy Title: Gender-Affirming Procedures.
Cigna level funding plan Treatment with gonadotropin-releasing hormone agents pubertal suppressantsbased upon a determination by a qualified medical https://quodsoftware.com/carefirst-bluechoice-quotes/8724-carefirst-animal-grace-park.php that an individual caresoutce eligible and ready for such treatment, i. Policy Issued By: Cigna. Coverage is available for medical, behavioral or pharmacological treatment that is Medically Necessary for Gender Dysphoria. Capacity to make a fully informed decision daresource to consent for treatment. Warnings Implantation of the device may make latent natural erections, as well as other interventional treatment options, impossible. Capacity to make a fully informed decision and to give consent for treatment; and.

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WebFor , CareSource Marketplace Plans feature the following benefits: Active&Fit Fitness benefit included with all optional Dental, Vision and Fitness plans. It includes . WebIndividual search queries were performed for CPT codes and which represent insertion of MPP and IPP, respectively. Data were recorded for each device, including . WebCareSource does not represent or warrant, whether expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose .