Gender Dysphoria and Gender Reassignment Surgery

CMS has not made a National Coverage Determination for gender reassignment surgery; therefore coverage for Medicare beneficiaries with gender dysphoria is decided by local Medicare Administrative Contractors on a case-by-case basis. Any local coverage decision must meet statutory requirements, including section 1862(a)(1)(A) (reasonable and necessary); this national policy does not specify documentation, frequency, or specific clinical criteria.

"Coverage for gender reassignment surgery for Medicare beneficiaries with gender dysphoria is determined by local Medicare Administrative Contractors (MACs) on a case-by-case basis (no national cove..."

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