BlueCross BlueShield of Tennessee Medical Policy Manual

Gender Reassignment Surgery

DESCRIPTION

Gender reassignment surgery or sex reassignment surgery are terms used to describe multiple medical and/or surgical treatments related to alleviating gender dysphoria. Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth.

Treatment options for gender dysphoria may include:

Definitions are from 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:

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) 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.

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.

Edwards-Leeper, L., & Spack, N. P. (2012). Psychological evaluation and medical treatment of transgender youth in an interdisciplinary "Gender Management Service" (GeMS) in a major pediatric center. Journal of Homosexuality, 59 (3), 321-336. (Level 5 evidence)

Hewitt, J. K., Paul, C., Kasiannan, P., Grover, S. R., Newman, L. K., & Warne, G. L. (2012). Hormone treatment of gender identity disorder in a cohort of children and adolescents. Journal of the Australian Medical Association, 196 (9), 578-581. (Level 4 evidence)

Palmetto Government Benefits Administrator (2017, April) Local Coverage Article: Gender reassignment services for gender dysphoria (A53793) Retrieved June 2, 2017 from https://www.cms.gov.

Spack, N. P., Edwards-Leeper, L. Feldman, H. A., Leibowitz, S., Mandel, F., & Diamond, D. A. (2012). Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics, 129 (3), 418-425. (Level 4 evidence)

Winifred S. Hayes, Inc. Medical Technology Directory. (2014, May; last update search April 2017). Sex reassignment surgery for the treatment of gender dysphoria.  Retrieved June 2, 2017 from www.Hayesinc.com.  (77 articles and or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2014, May; last update search April 2017). Ancillary procedures and services for the treatment of gender dysphoria. Retrieved June 2, 2017 from www.Hayesinc.com.  (56 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 September 13, 2013 from http://www.thisishow.org.

ORIGINAL EFFECTIVE DATE:  10/10/2013

MOST RECENT REVIEW DATE:  6/21/2017

ID_BT

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.