DEFINITION:

Gender reassignment refers to the hormonal and surgical reassignment of gender dysphoric persons.

Gender reassignment surgery, transsexual surgery, also known as sex reassignment surgery or intersex surgery, is the culmination of a series of procedures designed to change the anatomy of transsexuals to conform to their gender identity.

Transsexuals are persons with an overwhelming desire to change anatomic sex because of their fixed conviction that they are members of the opposite sex. For the male-to-female, transsexual surgery entails castration, penectomy and vulva-vaginal construction. Surgery for the female-to-male transsexual consists of bilateral mammectomy, hysterectomy and salpingo-oophorectomy, which may be followed by phalloplasty and the insertion of testicular prostheses.

COVERAGE:

Generally not covered subject to the Indications/Limits listed below.

Indications that are not covered

Transsexual surgery for sex reassignment of transsexuals is controversial. Because of the lack of well controlled, long-term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental. Moreover, there is a high rate of serious complications of these surgical procedures. For these reasons, transsexual surgery is not covered.

ADMINISTRATIVE PROCESS:

Requires Prior Authorization

PRODUCTS:

This policy applies:

• to all products administered by Medicare

Details of the Medicare Coverage Issues Manual, and the Local Medicare Coverage Decisions can be viewed at: http://www.hcfa.gov/pubforms/06_cim/ci00.htm and <http://www.wpsic.com/medicare/policy/Minnesota/1policies.html>.