Medicare AdvantageCoverageMedium impact
Gender Affirmation Surgery - Medicare Advantage
Humana·AL, GA, TN, NC, SC, VA, WV · Plastic Surgery, Urology, OB-GYN +2 more·Medicare Advantage
Effective date
Nov 3, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new coverage criteria for gender affirmation surgeries, effective November 3, 2025. The policy requires mental health referral letters, 6 months of hormone therapy, and surgical clearance for coverage of chest, gonadectomy and reconstructive procedures, while excluding many cosmetic procedures.
Action Required
Before November 3, 2025: Billing team must update prior authorization requirements for gender affirmation surgeries to include mental health referral letter with DSM-5 diagnosis documentation, proof of 6 months hormone therapy, and surgical clearance. Update encounter forms to remind providers of documentation requirements. Claims without proper documentation will be denied.