Gender Affirming Surgery

Aetna covers gender‑affirming surgeries (breast removal/augmentation, gonadectomy, and genital reconstructive procedures) as medically necessary when procedure‑specific criteria are met — key requirements include a signed readiness letter from a qualified mental health professional, documentation of marked and sustained gender dysphoria, exclusion of other causes, assessment of mental/physical health and capacity to consent, and typically a period of continuous, appropriate hormone therapy (commonly 6 months for adults, 12 months for adolescents <18, with some procedure‑specific exceptions or contraindications). The policy excludes many cosmetic transition procedures (e.g., most facial surgeries, body contouring, routine hair removal except limited sessions for skin‑graft prep), considers more than one breast augmentation not medically necessary, and lists numerous CPT/HCPCS codes as not covered.

"Gender‑affirming hormone therapy (including puberty suppression with GnRH agonists in adolescents and cross‑sex hormones for adolescents and adults) when clinically indicated for gender dysphoria."