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Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members – Policy Update Effective July 15

Audience: Physicians and other Health Care Practitioners

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on our website for review and comment here. Providers now have the capability of attaching supporting documentation related to their comments.
The following updated medical policy has been reviewed and was approved on March 24, 2022, by the Corporate Medical Policy Committee, including practitioner representatives from all Health Plan regions. The updated policy is effective July 15, 2022.
Corporate Medical Policy 7.01.84 – Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members has been updated to reflect New York state guidelines and The World Professional Association for Transgender Health (WPATH) recommendations. The policy applies to Commercial (HMO, PPO, POS, FEP, ASO/ASC, Indemnity and Essential Plan) and Medicare Advantage plans and to the services of all practitioners and facilities.

The Gender Affirming Surgery and Treatments for Commercial and Medicare Advantage Members policy provides updates to the criteria for the treatment of gender dysphoria.

The rationale section of the medical policy provides information related to the Health Plan’s change in coverage criteria based on DSM-5 criteria, assessment of peer-reviewed literature, and WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People.

These services are subject to audit and policy updates at the Health Plan’s discretion. Access the individual policies here.

If you have any questions regarding this policy, please contact your Provider Relations representative.

Thank you for the quality of care and service that you provide to our members.

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Policies & Clinical Criteria

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