Policy: Gender-Confirming Surgery
Last Update: 2020-10-08
Issued in: Minnesota

This policy applies to Medicaid

Breast Reconstruction:

In addition to these specific covered procedures, the following procedures may also be covered when medically necessary:

• Breast augmentation surgery for male-to-female GCS when the patient exhibits no response after adhering to hormone therapy for at least 24 months (unless contraindicated) and gender dysphoric symptoms remain after hormone treatment

Facial Reconstruction:

In addition to these specific covered procedures, the following procedures may also be covered when medically necessary:

• Facial surgery may be considered for coverage on a case-by-case basis. Factors that may be considered in the case-by-case analysis include:
  • How each requested procedure has a direct link to alleviating the documented symptoms of the gender dysphoria
  • Documentation showing that no other physical or behavioral health condition could be causing the distress that the facial surgery attempts to address
  • Explanation of how the symptoms will be alleviated through each requested procedure and how improvement will be measured and monitored.