US · guidance
CMS Pub. 100-03, ch. 1, § 140.9
Gender Reassignment Surgery for Gender Dysphoria
3 http://www.qualityforum.org/pdf/reports/sre.pdf
(Rev. 194, Issued: 03-03-17, Effective: 08-30-16, Implementation; 04-04-17)
A. General
Gender reassignment surgery is a general term to describe a surgery or surgeries that affirm a person’s
gender identity.
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
N/A
D. Other
The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that
focused on the topic of gender reassignment surgery. Effective August 30, 2016, after examining the
medical evidence, CMS determined that no national coverage determination (NCD) is appropriate at this
time for gender reassignment surgery for Medicare beneficiaries with gender dysphoria. In the absence of
an NCD, coverage determinations for gender reassignment surgery, under section 1862(a)(1)(A) of the
Social Security Act (the Act) and any other relevant statutory requirements, will continue to be made by the
local Medicare Administrative Contractors (MACs) on a case-by-case basis.
(This policy last reviewed August 2016.)
History
(Rev. 194, Issued: 03-03-17, Effective: 08-30-16, Implementation; 04-04-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
21dc02211474423ff591e1716d4dcdd62292573bb19bd082f477dfc945ce4a22
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