US · guidance
NCD 140.9
Gender Dysphoria and Gender Reassignment Surgery
Item/Service Description
A. General
Gender reassignment surgery is a general term to describe a surgery or surgeries that affirm a person's gender identity.
Indications and Limitations of Coverage
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.)
Revision History
03/2017 - Effective Date: 08/30/2016. Implementation Date: 04/04/2017. (TN 194) (CR9981)
History
Version 1
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-26
- Edition
- mcd-2026-08-26
- Content hash
30e09c0fe3cdbb530e858a666f8c04dc800e8cf4c34ec27a747eddd84b620f3c
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