Policy: Gender Dysphoria and Gender Reassignment Surgery (NCD 140.9) (Medicare Advantage)
Policy Number: MPG365.08
Last Update: 2023-05-10
This policy applies to Medicare
Notes:
The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that focused on the topic of gender reassignment surgery. After examining the medical evidence, CMS determined that no national coverage determination (NCD) is appropriate at this time for gender reassignment surgery for Medicare beneficiaries with gender dysphoria. In the absence of an NCD, coverage determinations for gender reassignment surgery, under section 1862(a)(1)(A) of the Social Security Act (the Act) and any other relevant statutory requirements, will continue to be made by the local Medicare Administrative Contractors (MACs) on a case-by-case basis
Updated on Nov 21, 2023