[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-280118-105":53,"doc-detail-280118-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","medical-coverage-policy-0266-gender-dysphoria-treatment-coverage-criteria","Medical Coverage Policy 0266 - Gender Dysphoria Treatment - Coverage Criteria","","Medical Coverage Policy 0266 addresses treatment of gender dysphoria, defining the condition as a marked incongruence between experienced/expressed gender and sex characteristics. It explains that coverage for gender dysphoria care, including gender reassignment surgery and related services, varies by plan and may depend on whether hormonal drugs are covered as medical or pharmacy benefits. The policy also notes potential impacts from state and federal mandates, instructing review of state-specific appendix guidance and applicable coverage limitations.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/medical-coverage-policy-0266-gender-dysphoria-treatment-coverage-criteria/280118/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/medical-coverage-policy-0266-gender-dysphoria-treatment-coverage-criteria/280118.png","ImageObject",442,249,{"name":88,"@type":89},"Graffin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-24","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What condition does this coverage policy address?","Question",{"text":108,"@type":109},"It addresses treatment of gender dysphoria, described as marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Does coverage for gender dysphoria treatment apply the same way to every plan?",{"text":113,"@type":109},"No. Coverage varies across plans, including whether hormonal therapy drugs are covered and whether they are handled as medical or pharmacy benefits.",{"name":115,"@type":106,"acceptedAnswer":116},"How do state and federal mandates affect coverage decisions?",{"text":117,"@type":109},"Coverage may be governed by state and/or federal mandates, and some state requirements may be more or less restrictive than the policy.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},280118,1790216326,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":76,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":141},3573418547284,"https://eur-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Medical Coverage Policy  \nEffective Date ....................9/1 5/20 26  \nNext Review Date ..............1/15/ 2027  \nCoverage Policy Number............. 0266  \nGender Dysphoria Treatment  \nTable of Contents  \nOverview ............................................. 2  \nCoverage Policy .................................... 2  \nCoding Information ............................... 7  \nGeneral Background ............................ 13  \nHealth Equity Considerations ................ 18  \nAppendix ........................................... 18  \nReferences ......................................... 21  \nRevision Details .................................. 23  \nRelated Coverage Resources  \nBlepharoplasty, Reconstructive Eyelid Surgery, and Brow Lift  \nBreast Reconstruction Following Mastectomy or  \nLumpectomy Breast Reduction Endometrial Ablation  \nExcimer Laser, Dermabrasion and Chemical Peels for Dermatologic Conditions Gonadotropin-Releasing Hormone Agonists –  \nCentral Precocious Puberty Gonadotropin-Releasing Hormone Agonists –  \nLupron Depot  \nGonadotropin-Releasing Hormone Agonists – Implants for Non-Oncology Indications Gonadotropin-Releasing Hormone Agonist –  \nSynarel  \nInfertility – Gonadotropin-Releasing Hormone Antagonists  \nInfertility Services  \nMale Sexual Dysfunction Treatment: Non-pharmacologic  \nPanniculectomy and Abdominoplasty  \nPartial Rhinectomy, Rhinoplasty, Vestibular Stenosis Repair and Septoplasty  \nPreventive Care Services Redundant Skin Surgery Testosterone (Injectable) Products  \nTestosterone (Oral, Topical, and Nasal) Products  \nTestosterone (Undecatrex)  \nINSTRUCTIONS FOR USE  \nThe following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients nd do not make coverage determinations. References to stan ard benefit plan language and  \ncoverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies and; 4) the specific facts of the particular situation. Each coverage request should be reviewed on its own merits. Medical directors are expected to exercise clinical judgment where appropriate and have discretion in making individual coverage determinations. Where coverage for care or services does not depend on specific circumstances, reimbursement will only be provided if a requested service(s) is submitted in accordance with the relevant criteria outlined in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this Coverage Policy (see “Coding Information” below). When billing, providers must use the most appropriate codes as of the effective date of the submission. Claims submitted for services that are not accompanied by covered code(s) under the applicabl","cbCaiaDGJICay2Uv","https://ap.wps.com/l/cbCaiaDGJICay2Uv","pdf",379207,24,"English","# Overview\n## Coverage Policy\n## Coding Information\n## General Background\n## Health Equity Considerations\n## Appendix\n## References\n## Revision Details","[{\"question\":\"What condition does this coverage policy address?\",\"answer\":\"It addresses treatment of gender dysphoria, described as marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics.\"},{\"question\":\"Does coverage for gender dysphoria treatment apply the same way to every plan?\",\"answer\":\"No. Coverage varies across plans, including whether hormonal therapy drugs are covered and whether they are handled as medical or pharmacy benefits.\"},{\"question\":\"How do state and federal mandates affect coverage decisions?\",\"answer\":\"Coverage may be governed by state and/or federal mandates, and some state requirements may be more or less restrictive than the policy.\"}]","Medical Coverage Policy 0266 - Gender Dysphoria Treatment - Coverage Criteria | PDF",1789533903,8]