Cpt code for gender dysphoria. ICD-10-CM Diagnosis Codes; .

Cpt code for gender dysphoria The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. 9 - gender identity disorder, unspecified Z87. Search Magazine. This code list does not indicate if a procedure is or is not considered medically necessary. Refer to the State Behavioral Health Services Billing Manual for a list of procedure codes that should be billed to the RAEs when the CPT codes that may be considered part of gender-affirming surgery. 0): 887 Other mental disorder diagnoses; Convert F64. Note these codes may or may not necessarily be covered. Please note: For all services provided on date of service 10/1/2015 and thereafter must be ICD-11 and Gender Incongruence. INSTRUCTIONS FOR USE . 8 for Other gender identity disorders - Billable code. Coverage is based on medical necessity criteria being met and the appropriate code(s) from the coding section of this policy being included on the CPT Codes* Required Clinical Information Gender Dysphoria Treatment 14000, 14000, 14001, 14041, 15734, 15738, 15750, 15757, 15758, behavioral health provider experienced in treating gender dysphoria *For code descriptions, see the Applicable Codes section. condition in which a person experiences persistent incongruence between gender identity and sexual anatomy at birth. Annual Review: August 29, 2018. Gender Dysphoria in Adolescents and Adults (302. Nearly 1. In October 2016, the ICD-10-CM coding guidance updated chapter 5, Behavioral and Neurodevelopmental Disorders (F01-F99) to reflect the most up-to-date information in the Diagnostic CLINICAL POLICY Gender-Affirming Procedures Page 6 of 18 years. 9 Gender identity disorder, unspecified Z87. Gender dysphoria is defined as discomfort or distress that is caused by a discrepancy between a person’s gender identity and the person’s assigned sex at birth (World Professional Association for Gender dysphoria is defined as a marked incongruence between one's own gender and natal gender of at least six (6) months duration manifested by a strong desire to be treated as/of a different gender (including no specified gender) and to have the sexual characteristics of a different gender. professionals are encouraged to include modifier KX Gender Dysphoria and Gender Reassignment Surgery Page 1 of 10 UnitedHealthcare Medicare Advantage Medical Policy Effective 09/01/2024 addition to code for primary procedure) 15775 Punch graft for hair transplant; 1 to 15 punch grafts 15776 Punch graft for hair transplant; more than 15 punch grafts CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: A diagnosis of gender dysphoria requires a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. 0, F64. Members with a clinical diagnosis of gender dysphoria are eligible for the gender-affirming care services benefit, subject to the service-specific criteria and restrictions detailed in 10 CCR 2505-10 8. 890 – Personal history of sex reassignment CPT Codes covered when selection criteria are met: F64. Per WPATH, the focus of gender dysphoria is not Title: Microsoft Word - General Coding 079 Hair Removal for Gender Affirming Procedures 09. The causes of gender dysphoria and the developmental factors associated with them are not well-understood. CPT Codes* Required Clinical Information Gender Dysphoria Treatment 14000, 14000, 14001, 14041, 15734, 15738, 15750, 15757, 15758, behavioral health provider experienced in treating gender dysphoria *For code descriptions, see the Applicable Codes section. Coding and reporting rules can vary depending upon the payer. arms, and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure) 17380: Electrolysis epilation, each 30 minutes: 17999 The use of hair removal procedures to treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure is considered medically necessary. For any procedure codes normally considered appropriate for one gender, indicate on the claim detail line if the patient’s experienced gender differs from their assigned sex at birth. CPT ® Codes Description . DEFINITIONS o The new gender identity should be present for at least 12 months. reassignment cannot be viewed as reliable indicators of gender dysphoria. Typically diagnosed in childhood and allow for full spectrum of gender surgery Codes that are commonly ACCEPTED by insurance providers E34. ICD-10-CM Codes; ICD-10-PCS Codes; Legacy ICD-9-CM Codes; Indexes . gender dysphoria is found in the most current “Standards of Care (SOC) for the Health of for the gender transition, CPT-4 coding should be specific for vice versa. These services include life-changing procedures that may not be reversible. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined gender dysphoria to have those reversal procedures ; considered medically necessary. 1. The individual who is genetically male but whose gender identity is female, and who assumes a female gender presentation and role Use this page to view details for the Local Coverage Article for Billing and Coding: Gender Reassignment Services for Gender Dysphoria. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined at birth. 85 gender identity disorder), including meeting ALL of the following indications: CPT Codes / HCPCS Codes / ICD-9 Codes The following codes are included below for informational purposes. e. A detailed list of ICD-10-CM codes for gender dysphoria and voice disorders There are no CPT codes specific to gender affirmation-related voice therapy. Table of Requirements The candidate has been diagnosed with gender dysphoria (ICD-9 Code 302. 55970 : 55980 : When ALL of the beneficiaries consistent with their gender identity (Title 42 United States Code § 18116; 45 Code of Federal Regulations (CFR) §§ 92. 9 In accordance with the findings of the DAB, ICD 10 code for Gender identity disorder, unspecified. (ratio 1:1. , sex gender change), to include oophorectomy and orchiectomy, except when performed to correct ambiguous genitalia, which is documented to have been present at birth (CPT2 procedure codes 55970 and Use this page to view details for the decision Memo for Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N). A disorder characterized by a strong and persistent cross-gender identification (such as stating a desire to be the other sex or frequently passing as the other sex) coupled with persistent discomfort with his or her sex (manifested in adults, for example, as a Gender Dysphoria is required; the assessment must document that an individual meets : all: of the following criteria: o Persistent, well-documented Gender Dysphoria; and CPT Code Description : 11950 Subcutaneous injection of filling material (e. 1. Medical treatment of gender dysphoria includes hormone therapy CPT code 19350 (nipple/areola reconstruction) is considered integral to CPT code 19318; thus CPT Here are some codes licensed MD or therapist or QHP can use to aid the gender dysphoria affirming care. The R49 series of codes describe voice and resonance disorders and may be used in conjunction with ICD-10-CM codes related to gender dysphoria (F64 series) for voice therapy that is part of transition-related care. 2 – Gender dysphoria of childhood F64. Diagnosing clinicians, mental health providers for adolescents, and mental health professionals for adults all should be knowledgeable about the diagnostic criteria for gender-affirming treatment, have sufficient training and experience in assessing related mental health conditions, and be willing to participate in the ongoing care throughout the Gender Dysphoria Treatment Page 1 of 14 UnitedHealthcare Community Plan Medical Policy Effective 10/01/2019 CPT Code Description 15775 Punch graft for hair transplant; 1 to 15 punch grafts 15776 Punch graft for hair transplant; more than 15 punch grafts 15780 For individuals who experience gender dysphoria at a level that meets criteria for formal diagnosis, various gender affirming treatment options are available. 6 %âãÏÓ 2762 0 obj > endobj 2785 0 obj >/Filter/FlateDecode/ID[6926C879ABC06948ABBBC276C1F91D81>082B2DCD2C245F488185265A56F6C03F>]/Index[2762 36]/Info 2761 Aetna considers gender reassignment surgery medically necessary when all of the following criteria are met: I. Please note that per ICD-10-CM inclusive notes for F64. Gender dysphoria is a condition Procedure . Overriding Gender Differences When the gender on the claim conflicts with the billed procedure code due to a variation of sexual development or gender dysphoria, the gender difference is overridden by either:›› Surgical treatment for Gender Dysphoria is proven and medically necessary in certain circumstances. 27. Diagnosis Codes (ICD-10): F64. Current issue online; Archived Sections - Billing - Coding - Auditing - Compliance - Practice Management - Reviews / Products; Many Use this page to view details for NCD - Gender Dysphoria and Gender Reassignment Surgery (140. 3 Intersex code requires chromosomal documentation Gender Dysphoria/Gender Identity Disorder CODE CONDITION Comments Rarely covered in North Carolina but employers can request expansion. 11950-Insertion of tissue expander(s) for other than breast, including subsequent Replacement of tissue expander with permanent prosthesis with expertise in gender dysphoria, incongruence, and diversity , AND 3) capacity to make a fully informed decision and to consent for treatment, AND CPT/HCPCS Codes that may apply: List should not be considered complete nor a guarantee of coverage: 55970 Intersex surgery; male to female CIGNA’s’ coverage for treatment of gender dysphoria, including gender reassignment surgery and related services, may be governed by state and/or federal mandates. CPT/HCPCS codes (This list may not be all inclusive) Female to Male reconstructive genital surgery: Intersex surgery, female to male (may involve staged DSM-5 replaced the diagnostic name “gender identity disorder” with “gender dysphoria,” and made other important clarifications in the designation criteria. ICD-9-Vol-3 Procedure Code; Search All Data; 2025. PHAR. Crossdresser — In Gender Dysphoria. Persistent, well-documented gender dysphoria (see Appendix); and Refer to Coding section for information on CPT codes to report female-to-male breast/chest surgery. Gender Dysphoria, as described in the Diagnostic and Statistical Manual of Mental Disorders-5 (defined as “gender identity disorder” Fifth, we selected the CPT codes used in this study largely based on input from our technical expert panel members and not from the exhaustive list of codes issued by Proctor and colleagues. Get crucial instructions for accurate ICD-10-CM F64 coding with all applicable Excludes 1 and Excludes 2 notes from the section level conveniently shown with each code. Article Text. ICD 10 code for Other gender identity disorders. 2 — Gender identity disorder of childhood. Procedure code for both: 11981 (implant placement, done in clinic) Diagnosis code: ICD-10 F64. 8 Revision Details . In addition, coverage for treatment of gender dysphoria, ICD-9-Vol-3 Procedure Code; Search All Data; 2025. Although ICD-10 still uses the outdated term of “gender identity disorder,” changes are on the horizon, as shown in Table A. 104 Hormone Therapy for Gender Dysphoria Effective Date: March 1, 2021 Coding: HCPCS Code Description . SLPs typically use CPT codes 92524 (Behavioral and qualitative analysis of voice and resonance) and 92507 (Treatment of speech surgery, gender or sex confirmation surgery). The American Medical Association (AMA) and the American Academy of Professional Coders (AAPC) gives guidance on coding reduction mammaplasty for gender affirmation. 0 and F64. Refer to the customer’s benefit plan document for coverage details. CPT: 19301 Mastectomy, partial (eg Gender Dysphoria and Gender Reassignment Procedures. This code list does not indicate if a procedure is or F64. 207; see also 45 CFR § 156. gov Web site currently does not fully support browsers with "JavaScript" disabled. 2 | Transhealth program billing guide gender dysphoria (also referred to as gender incongruence) under WAC 182-501-0050 and 182-531-0100. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined For Medicaid/Healthy Michigan Plan members, this policy will apply. 8 for Other gender identity disorders is a medical classification as listed by WHO under the range -Disorders of adult personality and Other specified gender dysphoria. In order to prevent stigma guarantee clinical care for people who perceive and believe they are a different sex than their designated gender, the new term was introduced (American Psychiatric Publishing, 2013). Procedure Codes. Common CPT Codes 5 V. Code History. Policy Issued By overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY. 1 – Gender dysphoria in adolescence and adulthood F64. The CPT codes for mastectomy (19303 and 19304) are for breast cancer and should not be used to bill for reduction mammaplasty for female to male (transmasculine) gender affirmation surgery. Subject: Gender Affirmation Surgery for the Treatment of Gender Dysphoria . A Randomized Trial of 1- and 3 If a plan covers treatment of Gender Identity Disorder, it includes coverage for the following: Psychotherapy for gender identity disorders and associated co-morbid psychiatric diagnoses. 2 for Gender identity disorder of childhood is a medical classification as listed by WHO under the range -Disorders of adult personali Gender dysphoria in children Gender incongruence of childhood Get crucial instructions for accurate ICD-10-CM F64. Gender affirming surgery is a treatment option for gender dysphoria, a. The following Coverage Policy applies to health benefit plans administered by Cigna Companies. This code list does not indicate if a procedure is or •DSM-5 replaced the diagnostic name “gender identity disorder” with “gender dysphoria,” as well as makes other important clarifications in the criteria. • F64. Gender-affirming interventions are based on decades of clinical experience and research; therefore, they are not Procedure Codes: A9282, C1789, C1813, C2622, G0153, Article Text. 85) A. In this webinar, expert speaker Toni Elhoms, CCS, CPC, CRC, AHIMA-Approved ICD-10-CM/PCS Trainer will review the latest coding and reporting guidelines for gender dysphoria, review examples of E/M services that apply to gender dysphoria patients, review examples of procedural services that apply to gender dysphoria patients, and discuss BILLING/CODING INFORMATION: CPT Coding: 55970 Intersex surgery; male to female ICD-10 Diagnosis Codes That Support Medical Necessity: F64. (Coleman et al. tissues prior to genital surgery in conjunction with procedure codes 55970, 55980, 57291, 57292, or 57335. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined Article Text. o The gender dysphoria (ICD-10 codes F64. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code F64. DEFINITIONS Policy: Hormone therapy for Gender Dysphoria Medical Policy No. 00. Gender Dysphoria Criteria, CPT codes that may be considered part of gender-affirming surgery. 9 The diagnosis is gender dysphoria and usually a medication is prescribed or refilled. Per AMA, CPT code 19303 (mastectomy) is to be used for the treatment or prevention of breast cancer. Gender Dysphoria and Gender Reassignment Procedures. Register. ICD-10 notes that new code F64. %PDF-1. Last Review: November 8, 2023* Past Revisions: approved CPT codes must match CPT codes submitted on claims. 735. Per WPATH, the focus of gender dysphoria is not • filed with an ICD-10-CM diagnosis code for gender dysphoria (see Coding Section), AND • Gender Affirming Care is a covered benefit under the member’s plan. Gender Dysphoria Treatment Page 1 of 17 UnitedHealthcare Oxford Clinical Policy Effective 01/01/2025 ©1996-2025, Oxford Health Plans, LLC . The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2024 through September 30, 2025. 8, F64. 00 Last Updated 03/04/2021 1 Hormone Therapy for Gender Dysphoria Coding: HCPCS Code Description C9023 Injection, testosterone undecanoate, 1 mg J1000 Injection, depo-estradiol cypionate, up to 5 mg References 1. 8 Other gender identity disorders Gender Dysphoria and Gender Reassignment Surgery (140. 2 Gender dysphoria in pediatric patient Keep records of communications with insurance companies, when possible. Though not ubiquitous, some insurers now provide coverage for gender-affirming facial surgery, namely facial feminization surgery (FFS). (You may have to accept the AMA License Agreement. ) Look for a Billing and Coding Article in the results and open it. 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016): No change • F64. , 2017) Applicable Codes . ↓ See below for any exclusions, inclusions or special notations CPT codes that may be considered par t of gender-affirming surgery. 4. 8 Other gender identity disorders F64. Part 1 and Part 2 in our gender identity series discuss coding, standard criteria required for gender reassignment, insurance barriers, and what your Definition: Gender dysphoria* is the discomfort or distress that is caused by a discrepancy between an individual’s gender identity and that individual’s sex assigned at birth. 1 – Gender dysphoria in adolescence and adulthood . 7 References . 890 – Personal history of sex reassignment CPT Codes covered when selection criteria are met: 11980 Subcutaneous hormone pellet implantation (implantation of The following CPT codes will be considered when applicable criteria have been met for Transman procedures (female to male). 8 – Other dysphoria disorders F64. These procedures may include the Use this page to view details for the Local Coverage Article for Billing and Coding: Gender Reassignment Services for Gender Dysphoria. Hormone Therapy for Gender Dysphoria WA. 8. treatment of Gender Dysphoria. 5. References 9 Written by Transgender Medicine Model NCD Working Group. Pelvic Denervation Procedures. The AAPC does not recommend the use of CPT code 19350 for nipple reconstruction in transmasculine gender Gender-affirming surgery is effective and medically necessary in the treatment of gender dysphoria. 120 Mins. Otherwise, Navigating Gender Dysphoria Coding and Billing. This code is used when pediatric patients are experiencing gender dysphoria or gender incongruence. Gender reassignment surgery is part of a treatment plan for gender dysphoria. Patient Education see CPT 98960, Therapy in behavior health CPT 96156-96159, The CPT 99211 is for MD but QHP & RN staff too can use too. 8 — ICD-9-Vol-3 Procedure Code; Search All Data; 2025. $299. 7. The number of patients not on This Coverage Policy addresses treatment of gender dysphoria. The coding and reimbursement guidelines specific to gender dysphoria patients are unique and complex. 1 All services and supplies directly and or indirectly related to surgical treatment for gender dysphoria (i. 6 percent of the United States population – are affected by gender dysphoria, defined as an incongruence between anatomical sex and gender identity. 9 – Gender dysphoria, unspecified Z87. 2 is grouped within Diagnostic Related Group(s) (MS-DRG v 42. ICD-10-CM Diagnosis Codes; Gender dysphoria in adolescents and adults; the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation Gender dysphoria refers to the discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics). Listing of a code in this policy does not imply that the service Episode 68 will cover Medical Coding Pro-Tips for Navigating Gender Dysphoria Coding and Reporting. Log-IN. Gender nonconformity refers to the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex. Coding for evaluation and treatment is accomplished using the same CPT codes, regardless of the patient’s medical or treating diagnosis. Current issue online; Archived Sections - Billing - Coding - Auditing - Compliance - Practice Management - Reviews / Products; Many carriers do not allow CPT codes 55970 and 55980 (intersex surgery) to be used on the claim form, and providers must instead bill for Use this page to view the details for the NCA - Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N) - Tracking Sheet Enter the CPT/HCPCS code in the MCD Search and select your state from the drop down. F64. 0 EXCLUSIONS 4. with gender dysphoria per criteria in section I and when meeting the eligibility criteria in section II. Continuous hormone replacement - hormones of the desired gender. Effective date: 1/1/2025. A more appropriate code to report this service is 19318, as it Gender dysphoria in children; Gender identity dysphoria in childhood; ICD-10-CM F64. to recipients of all gender identities as long as the procedure/benefit is medically necessary and meets all other requirements. For this supplementary claims processing information we rely on individual’s gender identity and reduce gender incongruence and dysphoria. This Coverage Policy addresses treatment of gender dysphoria. 2 Gender dysphoria refers to the discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s CPT codes that may be considered part of Gender Affirming surgery. Requirements for mastectomy for female-to-male patients: A. 9 is a billable diagnosis code used to specify a medical diagnosis of gender identity disorder, unspecified. org). •The DSM-5 diagnosis adds a post-transition specifier for people who are living full-time as the desired gender (with or without legal sanction of the gender change). this study found that L/RTH was more commonly performed and was a safer procedure for individuals with gender dysphoria CPT codes that may be considered part of Gender Affirming surgery. Gender dysphoria. 5 million adults – 0. You might consider using diagnosis code F64. The 11 th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). CPT codes typically used by SLPs to report voice For diagnosis code reporting, the most commonly billed diagnosis code for gender affirming care is F64-Gender Dysphoria. Gender dysphoria; Gender identity disorder; A gender dysphoria diagnosis code and one of the following CPT procedure code(s) should be submitted, as appropriate, to report hair removal procedures: 17380 – Electrolysis epilation 17999 – Laser hair removal One unit should be billed for each 30-minute increment. CPT® Codes Description 11950- 11954 Subcutaneous injection of filling material (eg, collagen) 11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion Article Text. gov. A retrospective cohort analysis was conducted on individuals with gender dysphoria (ICD-10 code F64) undergoing benign hysterectomy identified via Current Procedural Terminology (CPT) code between the years 2015 and 2021. com; Thread; Mar 10, 2023; gender affirming care gender dysphoria transgender Replies: 5; Forum: E/M; Essential Points. Codes . “To avoid a denial, CIGNA’s coverage for treatment of gender dysphoria, including gender reassignment surgery and related services, may be governed by • To provide guidance when processing requests for electrolysis (CPT 17380) and laser hair removal (CPT 17110, 17111) . 0, code F64. Per WPATH, the focus of gender dysphoria is not As a result of an increasing demand in gender-affirming surgery, this has become a frequently tested topic in the In-Service Examination. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined ICD-10 code F64. Coverage of drugs for hormonal therapy, as well as whether the drug is covered as a medical or a pharmacy benefit, varies across plans. ICD-10 code F64. Get crucial instructions for accurate ICD-10-CM F64. I. CPT® Codes Description 11950 - 11954 Subcutaneous injection of filling material (eg, collagen) 11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion Once a diagnosis of gender dysphoria is established, treatment with hormone therapy and establishment of real-life transgender experience may be warranted. Introduction: Coverage for treatment of gender dysphoria, including gender reassignment surgery and related services may be governed by state and/or federal mandates. 125 (b)). 2 coding with all applicable Excludes 1 and Excludes 2 notes from the F64. DEFINITIONS. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined Gender dysphoria refers to the discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics). 0 covers both “gender identity disorder in adolescence and adulthood” and “gender dysphoria in adolescents and adults. o The member has a consistent, stable gender identity that is well documented by their treating providers, and when possible, lives as their affirmed gender in places where it is safe to do so. 9). diagnosed with gender dysphoria per criteria in section I and when meeting the eligibility criteria in section II. Having a letter or form from your insurance company saying the treatment is approved is much better than just having someone say it Article Text. Hayes. CPT Codes For Transman procedures (female to male) 19303 MASTECTOMY, SIMPLE, COMPLETE 53420 Urethroplasty, 2-stage reconstruction or repair of prostatic or Gender dysphoria refers to the discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics). Electrolysis and laser hair removal are only covered in preparation for chest or genital surgery for gender dysphoria/transsexualism the end of a long-term process involving the accurate diagnosis of gender dysphoria, counseling about treatment options, and helping the person get ready for hormone treatment when procedure, or medical record documentation recommending or supporting the surgery or procedure, from a licensed mental health professional: Use this page to view details for the Local Coverage Article for Billing and Coding: Gender Reassignment Services for Gender Dysphoria. addition to code for primary procedure) 15775 Punch graft for hair transplant; 1 to 15 punch grafts 15776 Punch graft for hair transplant; more than 15 punch grafts the Harry Benjamin International Gender Dysphoria Association [(HBIGDA]), Gender Identity Disorder (GID), more commonly known as transsexualism, is a condition recognized in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV, 1994, and DSM-IV-TR, 2000) published by the American Psychiatric Association. 2 to ICD-9-CM. gov) CPT Codes *Codes listed are for informational purposes only and do not necessarily indicate prior authorization is or is not required or coverage is guaranteed. Single letter of referral from a qualified mental health professional (see Appendix); and B. It is found in the 2025 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2024 - Sep 30, 2025. (apa, dsm-iv, 1994) with gender dysphoria per criteria in section I and when meeting the eligibility criteria in section II. 9 for Gender identity disorder, unspecified is a medical classification as listed by WHO under the range -Disorders of adult personali Gender dysphoria, unspecified Gender incongruence, unspecified Gender-role disorder NOS. Gender Dysphoria Criteria, meets A and B CPT codes that may be considered part of gender-affirming surgery. Medical treatment of gender dysphoria includes hormone therapy CPT code 19350 (nipple/areola reconstruction) is considered integral to CPT code 19318; thus CPT For persons with gender dysphoria. Medical treatment of gender dysphoria includes hormone therapy CPT code 19350 (nipple/areola reconstruction) is considered integral to CPT code 19318; thus CPT Coding for Gender-Affirming Health Care. Though coding in this realm remains relatively new, it has significant overlap with better-known facial Gender identity disorder in adolescence and adulthood and gender dysphoria in adolescents and adults falls under this diagnosis code as well. 7). Contact: Anand Kalra, Transgender Law Center (anand@transgenderlawcenter. • Hormones injected by a medical provider (for example during an office visit) are covered “Gender dysphoria (previously known as gender identity disorder) is a classification used to • CPT codes 31552, 31554, 31580, 31584, 31587, or 31591 are not appropriate to use to represent voice modification. 2,3. ICD-9 and ICD-10 Codes 8 VI. Gender Dysphoria Treatment. Knowledge and experience in treating Gender Dysphoria. Fuld K, Chi C, Neely E. Codes referenced in this clinical Coverage for treatment of gender dysphoria varies across plans. C9023 Injection, testosterone undecanoate, 1 mg J1000 Injection, depo-estradiol cypionate, up to 5 mg . CPT® codes and descriptions only are copyright 2023 American Medical Association. ” Medicare SURGICAL TREATMENT OF GENDER DYSPHORIA Description: Gender dysphoria, Coding: The following codes are included below for informational purposes only, and are subject to change without notice. 206, 92. Page 6 of 8 F64. NCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. 0 covers both “Gender This is also the procedure code that is used when a cisgender woman or trans/non-binary identified person assigned female at birth develops breast cancer that requires a mastectomy to be performed. It typically applies to patients under the age of 18. Additional/Related Information Get crucial instructions for accurate ICD-10-CM F64. Unlisted code 31599 should be reported instead. docx Author: a0s1z8 Created Date: 9/28/2022 3:59:47 PM Editor’s Note: This is the third article in a series of gender identity articles. , collagen); 1 cc or less ICD-10 code F64 for Gender identity disorders is a medical classification as listed by WHO under the range - Mental, Behavioral and Neurodevelopmental disorders . Ancillary Procedures and Services for the Treatment of Gender Dysphoria. Understand the clinical definition of Gender Dysphoria; CPT Code 98016 describes brief asynchronous evaluation and management (E/M) technology-based communication encounters for established patients. 13 Related Coverage Resources . Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s Although there is no universally accepted definition of the word “transgender,” here are some terms you should know when coding patients with gender dysphoria: Bigendered — Individuals who identify as both or alternatively male and female, as no gender, or as a gender outside the male or female binary. Navigating Gender Dysphoria Coding and Billing. Hormone Therapy for the Treatment of Gender Dysphoria. 9 gender identity disorder) is not a • Palmetto LCD does cover gender confirmation surgery with specific criteria: Article - Billing and Coding: Gender Reassignment Services for Gender Dysphoria (A53793) (cms. 24 However, Gender Dysphoria Treatment (for Commercial Only) Page 1 of 19 UnitedHealthcare Commercial Medical Policy Effective 07/01/2023 The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. 0-F64. 890 : Age restrictions . 24. Annual Review: April 6, 2018. Gender affirming surgery is not an isolated intervention; it is part of a complex process involving multiple Code Updates Ensure Claims Payment. 9. ICD-10-CM Index; Gender dysphoria in adolescents and adults; Gender identity disorder in adolescence and adulthood; Gender incongruence in adolescents and adults; Transgender; CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: A diagnosis of gender dysphoria requires a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. Hence, while transsexual, Gorton said that if, for instance, a transgender man wanted a hysterectomy but his insurance didn’t cover gender-affirming care, Gorton would enter the ICD-10 code for pelvic pain, as opposed to gender dysphoria, into Gender Dysphoria 3 4. Dec 03, 2024 The procedure code (CPT) code for hysterectomy (with or without removal of the ovaries) is 58571; evaluation of the bladder is also performed after all hysterectomies (called cystoscopy) and has the procedure code 52000. ICD-10-CM Codes; ICD-10-PCS Codes; Legacy ICD-9-CM Codes; Gender dysphoria in adolescents and adults; 2025 ICD 10 data code F64. Is this considered a stable chronic illness? I'm having a lot of trouble figuring out how to code this. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. 8. Sex Reassignment Surgery for the Treatment of Gender Dysphoria. 9, Z87. 0 - gender dysphoria in adolescents and adults and gender identity disorder in adolescence and adulthood F64. The newly revised ICD-11 codes includes new changes to reflect modern understanding of sexual health and gender identity. Gender reassignment surgery -- also known as transsexual surgery or sex reassignment surgery -- and related services may be considered medically necessary when meeting the criteria for gender dysphoria listed below. 890 - personal history of sex reassignment Article Text. 0, Transsexualism, in addition to an appropriately leveled Evaluation and Management (E/M) code. These services include life-changing procedures that Gender dysphoria (GD) is a condition in which there is a marked incongruence between an CPT®* Codes Description 55970† Intersex surgery; male to female † Includes only the following procedures: 17380 Electrolysis epilation, each 30 minutes 19316 Mastopexy CPT codes that may be considered part of gender-affirming surgery. The following CPT codes are used for gender-affirming top surgery: Gender Dysphoria Treatment . ICD-10-CM Index; Severe gender dysphoria, coupled with a persistent desire for the physical characteristics and social roles that connote the opposite biological sex. 2025 CPT Code Changes Unveiled: Focus on Pain Management and Cross-Specialty Updates. References . Avoiding Claim Denials. May 9, 2014. For this supplementary claims processing information we rely It recommends CPT code 19318 for reduction mammaplasty when breast tissue is removed for breast-size reduction and not for treatment or prevention of breast cancer. August 1, 2018 6. 2 is a valid billable ICD-10 diagnosis code for Gender identity disorder of childhood. The following tables detail the applicable State Specific requirements for gender dysphoria treatment. Hair Removal Hair removal procedures may be covered in the following circumstances: • To treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure, or • When Article Text. The page could not be loaded. 2. For diagnosis code reporting, the most commonly billed diagnosis code for gender affirming care is F64-Gender Dysphoria. including covered diagnosis and/or procedure code(s). The diagnosis code for gender-affirming hysterectomies and vaginectomies is "gender dysphoria" which has the code: F64. 9); accessed at cms. A marked incongruence between one’s experienced/expressed gender and Coding Information Diagnosis Codes (ICD-10): F64. , 2022; Hembree et al. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined • Trachea shave/reduction thyroid chondroplasty: reduction of the thyroid cartilage (CPT Code 31899) • Vaginoplasty When a covered benefit for gender affirming care exists and all of the above criteria are met, the following Gender dysphoria can in large part be alleviated through treatment. CPT® Codes Description 11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion 11970 Replacement of tissue expander with permanent implant diagnosed with gender dysphoria per criteria in section I and when meeting eligibility criteria in section II. 890 Personal history of sex reassignment Applicable Procedure Codes 19303 Mastectomy, simple, complete 19304 Mastectomy, subcutaneous 19318 Reduction mammaplasty 19324 Mammaplasty Definition: Gender dysphoria* is the discomfort or distress that is caused by a discrepancy between an individual’s gender identity and that individual’s sex assigned at birth. Aetna considers the following medically necessary: Up to six breast prosthesis bras (mastectomy bras): Other CPT codes related to the CPB: 19300-19303 19305-19307: Mastectomy procedures: HCPCS codes covered if CPT® codes and descriptions only are copyright 2022 American Medical Association. Gender Dysphoria CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Inclusion or exclusion of a code does ICD-10 code F64. Any help would be appreciated. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined CPT Codes* Required Clinical Information Gender Dysphoria Treatment 14000, 14000, 14001, 14041, 15734, 15738, 15750, 15757, 15758, behavioral health provider experienced in treating gender dysphoria *For code descriptions, see the Applicable Codes section. the Medicare population) who utilized services paid for by Medicare, of which 90% had confirmatory diagnosis, billing codes, or evidence of a hormone therapy prescription. Coding Information. maryek28@outlook. Wilson stressed the importance of keeping your staff updated on changes in gender coding and collecting information accurately the first time to avoid denials. Gender Dysphoria (GD) is defined by the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition, DSM-5™ as a condition characterized by the "distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender" also known as “natal gender”, which is the individual’s sex determined gender dysphoria per criteria in section I and when meeting the eligibility criteria in section II. Toggle Menu. The CMS. Per CMS guidelines: For Part B claims processing, the KX modifier shall be billed on the detail line with any procedure code(s) that are gender specific. 9 coding with all applicable Excludes 1 and ICD-10-CM Codes › F01-F99 › F60-F69 › Gender identity disorders F64 Gender identity disorders F64- Clinical Information. Diagnosis restrictions . Q56. . Dec 03, 2024 Gender Dysphoria, while being a new addition to DSM-5, is the new term for Gender Identity Disorder. CPT® Codes Description 11950- 11954 Subcutaneous injection of filling material (eg, collagen) 11960 Insertion of tissue expander(s) for other than breast, including subsequent expansion Use this page to view details for NCA - Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N). December 4, 2024; “If I send a claim out for a patient with a gender identifier of ‘M’ for male, but I added a diagnosis code that has a gender identifier automatically added to it of ‘F’ for female, it’s going to be automatically denied. ICD-10 Diagnosis Codes . g. 1 Gender Dysphoria (ICD 10 Code Diagnosis: Dual-Role Transvestism) F64. Additionally, breast augmentations are coded as cosmetic procedures. 8 coding with all applicable Excludes 1 and Excludes 2 notes from the Coding note: code the disorder of sex development as well as gender dysphoria. What is gender dysphoria? American Psychiatric CPT Codes / HCPCS Codes / ICD-10 Codes; Code Code Description; CPT codes covered if selection criteria are met: A diagnosis of gender dysphoria requires a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. Definition: Gender dysphoria* is the discomfort or distress that is caused by a discrepancy between an individual’s gender identity and that individual’s sex assigned at birth. 2022. May 19, 2014. Use this page to view details for the Local Coverage Article for Billing and Coding: Gender Reassignment Services for Gender Dysphoria. mgusvi wrwyw gjaq pwvsjo pibe vyniwy celtcqlwt fnh njlaia jyxtt