High impact
Gender Affirming Surgery (CPB 0615, reviewed 2026-07-17)
Aetna·Effective Jul 17, 2026
Aetna has issued a comprehensive clinical policy (CPB 0615) defining medical necessity criteria for gender affirming surgeries, including breast removal, breast augmentation, gonadectomy, and genital reconstructive procedures. The policy establishes specific requirements (mental health evaluation, hormone therapy duration, documentation standards) for coverage and explicitly designates certain procedures (facial surgery, body contouring, tracheal shave, hair removal except for graft prep) as non-covered cosmetic services. Billing teams must immediately implement prior authorization requirements and documentation validation for covered procedures.