Gender Affirmation Surgery - Medicare Advantage

Covers gender-affirming (gender reassignment/sex reassignment) surgical procedures to alter primary and/or secondary sex characteristics—examples include breast augmentation/reduction, mastectomy, hysterectomy, orchiectomy, metoidioplasty, clitoroplasty, labiaplasty, penectomy, nipple/areola reconstruction, and related procedures. Coverage is for individuals with gender dysphoria (marked incongruence persisting ≥6 months with clinically significant distress/impairment) but is determined by CMS NCD 140.9 and the applicable Medicare Administrative Contractor LCDs/LCAs, varies by jurisdiction, and is subject to Medicare medical‑necessity rules and general cosmetic exclusions.

"This document excerpt does not itself authorize coverage; where MAC LCDs/NCDs differ by jurisdiction, coverage will vary accordingly."

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