![]() Policy Title: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services Policy Issued By: Blue Cross Blue Shield of Illinois Feminizing procedures including Rhinoplasty, face-lifting, lip enhancement, facial bone reduction, blepharoplasty, breast augmentation, liposuction of the waist (body contouring), reduction of hyoid (chondroplasty), hair removal, voice modification surgery (laryngoplasty or shortening of the vocal cords), and skin resurfacing.The following procedures are considered cosmetic and not a covered benefit include, but are not limited to: Policy Title: Gender Reassignment Surgery Thyroid cartilage reduction (chondroplasty).Hair removal (for example, electrolysis or laser) and hairplasty, when the criteria above have not been met.The following procedures, when requested alone or in combination with other procedures, are considered cosmetic and not medically necessary when applicable reconstructive criteria above have not been met, or when used to improve the gender specific appearance of an individual who has undergone or is planning to undergo gender affirming surgery, including, but not limited to, the following: Policy Issued By: Anthem Blue Cross Blue Shield Policy Issued By: Anthem Blue Cross (California) Requires supporting documentation that indicates procedures requested are medically necessary. Policy Title: Clinical Guidelines and Coverage Criteria for the Treatment of Gender Dysphoria One letter, signed by the referring qualified mental health professional* who has independently assessed the individual, is required the letter must have been signed within 12 months of the request submission.Existing vocal presentation demonstrates significant variation from normal for the experienced gender and.If the individual is diagnosed with severe psychiatric disorders and impaired reality testing (for example, psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder), an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated and If the individual has significant medical or mental health issues present, they must be reasonably well controlled.For gender masculinization only: for individuals without a medical contraindication or intolerance, the individual has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician and.The individual has been diagnosed with gender dysphoria (see Discussion section for diagnostic criteria) and.The individual has capacity to make fully informed decisions and consent for treatment and.The individual is at least 18 years of age and.Gender affirming voice modification surgery is considered reconstructive when all of the following criteria have been met: These are a list of clinical criteria that have explicit coverage for voice therapy or surgery.
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