CommercialPrior AuthMedium impact
Gender Dysphoria Treatment in Adults
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Urology, Plastic Surgery +2 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy establishes comprehensive coverage criteria for gender dysphoria treatment in adults, including feminizing/masculinizing hormone therapy and gender reassignment surgery. Prior approval is required for all gender reassignment surgeries, and hormone therapy requires referral from qualified mental health professionals with specific documentation requirements.
Action Required
Immediately: Billing team must implement prior authorization requirements for all gender reassignment surgeries. Update billing system to flag these procedures for prior approval. For hormone therapy claims, verify referral documentation from qualified mental health professionals is on file including DSM-5 diagnosis, treatment duration, and informed consent statements. Train staff to identify gender dysphoria treatment codes and ensure proper documentation requirements are met before claim submission.