MedicaidCoverageMedium impact
Updated Guidance - Expanded Medicaid Coverage of Gender-Affirming Treatments
Maryland Medicaid·MD · Endocrinology, Plastic Surgery, General Surgery +5 more·Provider Transmittal
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid significantly expanded coverage for gender-affirming treatments effective January 1, 2024, including hormone therapy, surgical procedures, voice therapy, and fertility preservation. The policy requires specific documentation of medical necessity from qualified healthcare professionals and includes comprehensive CPT codes with reimbursement rates.
Action Required
Immediately: Billing team must access the comprehensive CPT code list and reimbursement rates at https://bit.ly/485Hpti to update billing system for newly covered gender-affirming treatments. Update encounter forms to include documentation requirements for medical necessity. Providers must ensure proper documentation from Mental Healthcare Professionals or Somatic Healthcare Professionals for adults, or multidisciplinary teams for adolescents. Claims without proper documentation will not meet coverage requirements.