[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-280117-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-280117-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","unitedhealthcare-medical-policy-gender-dysphoria-treatment","UnitedHealthcare Medical Policy - Gender Dysphoria Treatment","","UnitedHealthcare’s Medical Policy for Gender Dysphoria Treatment defines when surgical and related interventions may be medically necessary for eligible individuals. It specifies applicability across Commercial and Individual Exchange plans, including state- or plan-specific exclusions that route to separate benefit guidance. Coverage rationale requires persistent, well-documented gender dysphoria, informed consent capacity, at least 18 years of age, and favorable psychosocial-behavioral assessment. Additional, procedure-specific evidence is required for breast, voice/thyroid cartilage and genital surgeries, including duration of hormone therapy, qualified professional clinical assessments, real-life experience, and ongoing follow-up requirements.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/general/","General",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/unitedhealthcare-medical-policy-gender-dysphoria-treatment/280117/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/unitedhealthcare-medical-policy-gender-dysphoria-treatment/280117.png","ImageObject",442,249,{"name":42,"@type":43},"McGucket","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-21","2026-09-16",true,{"@type":52,"interactionType":53,"userInteractionCount":22},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Which individuals may qualify for surgical treatment for Gender Dysphoria under this policy?","Question",{"text":62,"@type":63},"Surgical treatment may be indicated when the individual has persistent, well-documented gender dysphoria, can make a fully informed decision and consent, is at least 18 years old, and has a favorable psychosocial-behavioral evaluation including risk factor screening.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What additional requirements apply for breast surgery coverage?",{"text":67,"@type":63},"In addition to general eligibility criteria, coverage requires a written clinical assessment from at least one Qualified Healthcare Professional experienced in treating Gender Dysphoria. For breast augmentation, continued gender dysphoria after 12 months of continuous hormone therapy prior to the procedure is required.",{"name":69,"@type":60,"acceptedAnswer":70},"What documentation is needed for genital surgery coverage?",{"text":71,"@type":63},"Coverage requires written clinical assessment from at least two Qualified Healthcare Professionals who independently assessed the individual. The assessments must document at least 12 months of successful continuous full-time real-life involvement in the identified gender and 12 months of appropriate continuous hormone therapy, plus a treatment plan with ongoing follow-up by a Qualified Healthcare Professional.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},280117,1789959018,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,113,118,123],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social 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.......................................................................... 1  \nCoverage Rationale ............................................................ 2  \nMedical Records Documentation Used for Reviews.............3  \nDefinitions ........................................................................... 3  \nApplicable Codes ................................................................4  \nDescription of Services........................................................ 8  \nBenefit Considerations ........................................................ 8  \nClinical Evidence................................................................. 9  \nU.S. Food and Drug Administration ................................... 17  \nReferences ....................................................................... 17  \nPolicy History/Revision Information ................................... 19  \nInstructions for Use ........................................................... 20  \n\n| Related Commercial/Individual Exchange Policies |\n| --- |\n| •  Botulinum Toxins A and B\u003Cbr>•  Breast Reconstruction\u003Cbr>•  Breast Reduction Surgery\u003Cbr>•  Brow Ptosis and Eyelid Repair\u003Cbr>•  Cosmetic and Reconstructive Procedures\u003Cbr>•  Gonadotropin Releasing Hormone Analogs\u003Cbr>•  Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech)\u003Cbr>•  Infertility Diagnosis, Treatment, and Fertility Preservation\u003Cbr>•  Panniculectomy Surgery\u003Cbr>•  Rhinoplasty and Other Nasal Surgeries |\n\n\n| Community Plan Policy |\n| --- |\n| •  Gender Dysphoria Treatment |\n\nApplication  \nUnitedHealthcare Commercial  \nThis Medical Policy applies to UnitedHealthcare Commercial benefit plans, except for those listed below:  \n\n| Plan | Policy/Guidelines |\n| --- | --- |\n| California fully-insured group plans | Refer to the Benefit Interpretation Policy titled Gender Dysphoria (Gender Identity Disorder) Treatment (for California Only) |\n| Washington fully-insured group plans | Refer to the Benefit Interpretation Policy titled Gender Dysphoria (Gender Identity Disorder) Treatment (for Washington Only) |\n\nUnitedHealthcare Individual Exchange  \nThis Medical Policy applies to Individual Exchange benefit plans in all states, except for those listed below:  \n\n| State | Policy/Guidelines |\n| --- | --- |\n| Alabama, Arizona, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nebraska, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Wisconsin , Wyoming | Refer to the member specific benefit plan document |\n| Washington | Refer to the Benefit Interpretation Policy titled Gender Dysphoria (Gender Identity Disorder) Treatment (for Washington Only) |\n\nCoverage Rationale  \n􀃂 See Benefit Considerations  \nNote: This Medical Policy does not apply to individuals with ambiguous genitalia or disorders of sexual development.  \nSurgical treatment for Gender Dysphoria may be indicated for individuals who provide documentation that the individual meets all of the following criteria:  \n Persistent, well-documented Gender Dysphoria ; and  \n Capacity to make a fully informed decision and to consent for treatment; and  \n Must be at least 18 years of age; and  \n Favorable psychosocial-behavioral evaluation including screening and identification of risk factors or potential postoperative challenges  \nFor breast surgery (mastectomy, breast reduction, or breast augmentation) , in addition to the above criteria, a written clinical assessment from at least one Qualified Healthcare Professional experienced in treating Gender Dysphoria is required; the assessment must document that an individual meets the following criteria:  \n For breast augmentation, continued Gender Dysphoria following the completion of 12 months of continuous hormone therap","cbCaimdab3Y8Zfpq","https://ap.wps.com/l/cbCaimdab3Y8Zfpq","pdf",574431,20,"English","# Application\n## UnitedHealthcare Commercial\n## UnitedHealthcare Individual Exchange\n# Coverage Rationale\n## Eligibility criteria for surgical treatment\n## Procedure-specific requirements (breast, voice, genital)\n# Definitions\n# Applicable Codes\n# Description of Services\n# Benefit Considerations\n# Clinical Evidence\n# References\n# Policy History/Revision Information","[{\"question\":\"Which individuals may qualify for surgical treatment for Gender Dysphoria under this policy?\",\"answer\":\"Surgical treatment may be indicated when the individual has persistent, well-documented gender dysphoria, can make a fully informed decision and consent, is at least 18 years old, and has a favorable psychosocial-behavioral evaluation including risk factor screening.\"},{\"question\":\"What additional requirements apply for breast surgery coverage?\",\"answer\":\"In addition to general eligibility criteria, coverage requires a written clinical assessment from at least one Qualified Healthcare Professional experienced in treating Gender Dysphoria. For breast augmentation, continued gender dysphoria after 12 months of continuous hormone therapy prior to the procedure is required.\"},{\"question\":\"What documentation is needed for genital surgery coverage?\",\"answer\":\"Coverage requires written clinical assessment from at least two Qualified Healthcare Professionals who independently assessed the individual. The assessments must document at least 12 months of successful continuous full-time real-life involvement in the identified gender and 12 months of appropriate continuous hormone therapy, plus a treatment plan with ongoing follow-up by a Qualified Healthcare Professional.\"}]","UnitedHealthcare Medical Policy - Gender Dysphoria Treatment | PDF",1789533902,7]