LCD/NCD Portal

NCD140.3

 

TRANSSEXUAL SURGERY

 

 

Effective Date of this Version

• This is a longstanding national coverage determination.

• The effective date of this version has not been posted.

 

Benefit Category

• Physicians' Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• Transsexual surgery, also known as sex reassignment surgery or intersex surgery is the culmination of a series of procedures designed to change the anatomy of transsexuals to conform to their gender identity.

• Transsexuals are persons with an overwhelming desire to change anatomic sex because of their fixed conviction that they are members of the opposite sex.

• For the male-to-female, transsexual surgery entails castration, penectomy and vulva-vaginal construction.

o Surgery for the female-to-male transsexual consists of bilateral mammectomy, hysterectomy and salpingo-oophorectomy, which may be followed by phalloplasty and the insertion of testicular prostheses.

 

Indications and Limitations of Coverage

• Transsexual surgery for sex reassignment of transsexuals is controversial.

• Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental.

• Moreover, there is a high rate of serious complications for these surgical procedures.

o For these reasons, transsexual surgery is NOT covered.

 

 

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