GUIDELINE NOTE 127, GENDER DYSPHORIA Home Page
GUIDELINE NOTE 127, GENDER AFFIRMING TREATMENTLine 309Gender affirming treatments are included on this line according to the provisions of House Bill 2002 (2023), when provided according to Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, published by the World Professional Association of Transgender Health (WPATH), whether or not the code for the service appears on the line. These services are included for gender affirming treatment or for any condition represented on this line. To simplify administration, the line includes a variety of procedures that may be considered medically necessary and prescribed in accordance with the WPATH 8.0 standards of care.Gender affirming treatments billed using CPT or HCPCS codes not on this line must also be covered in accordance with the provisions of the bill.In addition, the bill prohibits denial or limitation of services determined to be medically necessary by the provider who prescribed the treatment, prohibits denying or limiting services considered by plans to be ‘cosmetic’ and requires that any denial or limit be reviewed and upheld by a provider with experience prescribing or delivering gender affirming treatment. ................
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