National Coverage Analysis (NCA) Tracking Sheet

Gender Dysphoria and Gender Reassignment Surgery



Gender dysphoria (previously known as gender identity disorder) is a classification used to describe persons who experience significant discontent with their biological sex and/or birth gender. Therapeutic options for gender dysphoria include behavioral and psychotherapies, hormonal treatments, and a number of surgeries used for gender reassignment.

CMS received a request to review the available evidence and conduct a national coverage determination (NCD) review to determine whether health outcomes are improved from treatment for Gender Dysphoria and Gender Reassignment Surgery.

CMS has no National Coverage Determinations for Gender Dysphoria and Gender Reassignment Surgery.

CMS is soliciting public comment relevant to the request. We are particularly interested in comments that include scientific evidence and that address the breadth of the request.

Benefit Category

Physicians' Services

Requestor Information

Requestor Name Requestor Letter
Nehael Shields View Letter

Important Dates

Formal Request Accepted and Review Initiated
Expected NCA Completion Date
Public Comment Period
12/03/2015 - 01/02/2016
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
06/02/2016 - 07/02/2016
Decision Memo Released
Comments for this NCA
View Public Comments


Lead Analysts
Linda Gousis, J.D.
Lead Medical Officers
James Rollins, MD

Medicare Benefit Category Determination Date

Actions Taken

December 3, 2015

CMS opens this NCD on Gender Dysphoria and Gender Reassignment Surgery. The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days. CMS considers all public comments and is particularly interested in clinical studies and other scientific information relevant to the topic under review.

Instructions on submitting comments can be found on the website at:

To submit a comment, please use the orange "Comment" button at the top of the page. Enter comments directly into the "Submit A Public Comment" webpage. CMS redacts all personal identifiable information (PII) and protected health information (PHI) before posting public comments. We recommend refraining from using PII and PHI in any public comment submitted.

June 2, 2016

August 30, 2016