Policy: Gender Dysphoria and Gender Reassignment Surgery (NCD 140.9) (Medicare Advantage)
Policy Number: MPG365.03
Last Update: 2020-05-13

This policy applies to Medicare

Breast Reconstruction:

Listing CPT 19325 Mammaplasty, augmentation; with prosthetic implant
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.

Facial Reconstruction:

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.