MedicaidCoverageHigh impact
Expanded Medicaid Coverage of Gender-Affirming Treatment, Effective January 1, 2024
Maryland Medicaid·MD · Psychiatry, Endocrinology, General Surgery +2 more·Provider Transmittal
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Effective January 1, 2024, Maryland Medicaid significantly expanded coverage of gender-affirming treatments including hormone therapy, puberty blockers, surgical procedures (chest, face, genitals, etc.), voice therapy, fertility preservation, and laser scar treatment. This policy supersedes PT 37-16 and establishes new preauthorization requirements: adults need one assessment letter from a mental health or primary care provider competent in transgender care; adolescents require letters from a multidisciplinary team. Billing teams must update systems to reflect newly covered services and enforce documentation requirements.
Action Required
By December 31, 2023: (1) Billing team must update billing software to recognize newly covered gender-affirming treatment codes and configure system to require prior authorization documentation before claims submission. (2) Obtain and implement the comprehensive CPT code list with reimbursement rates from https://bit.ly/47MihHs—this resource contains the specific billing codes not enumerated in the transmittal text. (3) Clinical staff and providers must be trained on new documentation requirements: for adult patients, collect at least one letter of assessment from a Mental Healthcare Professional or Somatic Healthcare Professional/Primary Care Provider with competencies in transgender care; for adolescents, collect assessment letters from a multidisciplinary team including both somatic and mental health professionals. (4) Update encounter forms, EMR templates, and prior authorization request processes to prompt providers to obtain and submit required assessment letters before treatment authorization. (5) Providers and billing staff should review the linked clinical guidance and provider templates at https://bit.ly/47MihHs. Consequence of inaction: Claims for gender-affirming treatments submitted without proper documentation and prior authorization will be denied; non-compliance may result in billing delays and claim rejections for Maryland Medicaid members.