Horizon bcbs direct access providers8/30/2023 ![]() 65) recommended that male-to-female members undergo feminizing hormone therapy (minimum of 12 months) prior to breast augmentation surgery. ( NOTE: Although not an explicit criterion, WPATH Standards of Care (Revision 7 p. If significant medical or mental health concerns are present, they must be reasonably well controlled.Age of majority (18 years of age or older) and.Persistent, well-documented gender dysphoria ( see Policy Guidelines I) and.Criteria for breast augmentation (implants/lipofilling) in male-to-female members:.However, different approaches may be more suitable, depending on an adolescent’s specific clinical situation and goals for gender identity expression.”) The intent of this suggested sequence is to give adolescents sufficient opportunity to experience and socially adjust in a more masculine gender role, before undergoing irreversible surgery. According to the WPATH Standards of Care 7th Edition, ”Chest surgery in female-to-male patients could be carried out earlier, preferably after ample time of living in the desired gender role and after one year of testosterone treatment. ( NOTE: Hormone therapy is not a prerequisite. ![]() ![]() Age of majority (18 years of age or older) - For members younger than 18 years of age, please see NOTE below and.Capacity to make a fully informed decision and to give consent for treatment and.Persistent, well-documented gender dysphoria (see Policy Guidelines I) and.Single letter of referral from a qualified mental health professional (see Policy Guidelines II, III), and.Criteria for mastectomy and creation of a male chest in female-to-male members:.liposuction (e.g., reduce fat in hips, thighs, and buttocks).voice modification surgery to obtain a deeper voice (rarely done per WPATH Standards of Care ).Procedures that assist in masculinization (female-to-male):.gluteal augmentation (implants/lipofilling).hair reconstruction / hair removal / electrolysis.voice modification surgery (vocal cord shortening).facial feminization surgery / facial bone reduction / jaw shortening / sculpturing.suction-assisted lipoplasty of the waist.reduction thyroid chondroplasty (trachea shave).Procedures that assist in feminization (male-to-female):.These include, but may not be limited to, the following: Non-genital, non-breast aesthetic surgical procedures are considered cosmetic in nature, even in the presence of a contract benefit for gender affirming surgery.Policy: Gender Reassignment/Gender Affirming Surgery Policy Number: 115
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