Policy: Gender Affirming Surgery
Policy Number: 0615
Last Update: 2021-01-12
This policy applies to Medicaid
Breast Reconstruction:
Requirements for breast augmentation (implants/lipofilling):
Note: More than one breast augmentation is considered not medically necessary. This does not include the medically necessary replacement of breast implants (see CPB 0142 - Breast Implant Removal).
Youth Services:
Mastectomy: members below the age of majority (less than 18 years of age), completion of one year of testosterone treatment;
Updated on Aug 27, 2021