BlueCross BlueShield of Tennessee Medical Policy Manual

Gender Reassignment Surgery

DESCRIPTION

Gender reassignment surgery is a term used to describe multiple medical and/or surgical treatments related to alleviating gender dysphoria. Gender is a term that refers to the psychological and cultural characteristics associated with biological sex. It is a psychological concept and sociological term, not a biological one. Gender identity refers to an individual’s awareness of being male or female and is sometimes referred to as an individual’s “experienced gender.” Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s biology.

According to the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 provided by the World Professional Association for Transgender Health treatment options for gender dysphoria may include:

Definitions:

Refer to the Gender Reassignment Precertification Request Form

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

According to the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 provided by the World Professional Association for Transgender Health (WPATH) letter criteria for each referral letter should address all of the following topics:

SOURCES 

American Academy of Child & Adolescent Psychiatry.  (2012, September). Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents. Retrieved June 2, 2017 from www.jaacap.org.

American Psychiatric Association. (2011, September).  Report of the APA Task Force on Treatment of Gender Identity Disorder. Retrieved September 16, 2013 from https://www.psychiatry.org.

Colebunders, B., Brondeel, S., D’Arpa, S., Hoebeke, P., & Monstrey, S. (2016). An update on the surgical treatment for transgender patients. Sexual Medicine Reviews, 16, 30032-30034. Abstract retrieved September 15, 2016 from PubMed database.

Delgado-Ruiz, R., Swanson, P., & Romanos, G. (2019). Systematic review of the long-term effects of transgender hormone therapy on bone markers and bone mineral density and their potential effects in implant therapy. Journal of Clinical Medicine, 8 (6), 784. (Level 2 evidence)

Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A., La°ngstro¨m, N., and Lande´n, M. (2011, February). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PLOS One, 6 (2), e16885. (Level 2 evidence)

Djordjevic, M. L., Bizic, M. R., Duisin, D., Bouman, M. B., & Buncamper, M. (2016). Reversal surgery in regretful male-to-female transsexuals after sex reassignment surgery. Journal of Sexual Medicine, 13 (6), 1000-1007. Abstract retrieved September 15, 2016 from PubMed database.

European Society for Sexual Medicine. (2020). Position statement “assessment and hormonal management in adolescent and adult trans people, with attention for sexual function and satisfaction.” Retrieved November 20, 2020 from https://www.essm.org/.

Winifred S. Hayes, Inc. Medical Technology Directory. (2018, August; last update search September 2020). Sex reassignment surgery for the treatment of gender dysphoria.  Retrieved November 20, 2020 from www.Hayesinc.com/subscribers. (92 articles and or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2020, June). Reversal of gender reassignment surgery. Retrieved November 20, 2020 from www.Hayesinc.com/subscribers. (6 articles and or guidelines reviewed)

World Professional Association for Transgender Health (WPATH). (2011). Standards of Care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Retrieved November 20, 2020 from https://www.wpath.org/publications/soc. 

Zucker, K., Nabbijohn, A., Santarossa, A., Wood, H., Bradley, S., Matthews, J., & VanderLaan, D. (2017). Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher’s Report Form. Child, Adolescent Psychiatry & Mental Health. 11 (15), 1-8. (Level 4 evidence)

ORIGINAL EFFECTIVE DATE:  10/10/2013

MOST RECENT REVIEW DATE:  1/14/2021

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.