Gender Dysphoria and Gender Reassignment Surgery

CMS National Coverage Determination | ncd_id=368 | manual_section=140.9 | coverage_level_code=4 | national_coverage_type=True | under_review=True | lab_ncd=False

B. Nationally Covered Indications N/A C. Nationally Non-Covered Indications N/A D. Other The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that focused on the topic of gender reassignment surgery. Effective August 30, 2016, after examining the medical evidence, CMS determined that no national coverage determination (NCD) is appropriate at this time for gender reassignment surgery for Medicare beneficiaries with gender dysphoria. In the absence of an NCD, coverage determinations for gender reassignment surgery, under section 1862(a)(1)(A) of the Social Security Act (the Act) and any other relevant statutory requirements, will continue to be made by the local Medicare Administrative Contractors (MACs) on a case-by-case basis. (This policy last reviewed August 2016.)

Item/Service Description: A. General Gender reassignment surgery is a general term to describe a surgery or surgeries that affirm a person's gender identity. Revision History: 03/2017 - Effective Date: 08/30/2016. Implementation Date: 04/04/2017. ( TN 194 ) (CR9981) Benefit Categories: 52 - Physicians' Services Transmittal: transmittal_number=194 | transmittal_issue_date=2017-03-03 | change_request_number=9981