National Coverage Determination (NCD)

Gender Dysphoria and Gender Reassignment Surgery


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Tracking Information

Publication Number
Manual Section Number
Manual Section Title
Gender Dysphoria and Gender Reassignment Surgery
Version Number
Effective Date of this Version
Implementation Date

Description Information

Benefit Category
Physicians' Services

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

Item/Service Description

A.     General

Gender reassignment surgery is a general term to describe a surgery or surgeries that affirm a person's gender identity.

Indications and Limitations of Coverage

B.     Nationally Covered Indications


C.    Nationally Non-Covered Indications


D.    Other

The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that focused on the topic of gender reassignment surgery. Effective August 30, 2016, after examining the medical evidence, CMS determined that no national coverage determination (NCD) is appropriate at this time for gender reassignment surgery for Medicare beneficiaries with gender dysphoria. In the absence of an NCD, coverage determinations for gender reassignment surgery, under section 1862(a)(1)(A) of the Social Security Act (the Act) and any other relevant statutory requirements, will continue to be made by the local Medicare Administrative Contractors (MACs) on a case-by-case basis.

(This policy last reviewed August 2016.)

Transmittal Information

Transmittal Number
Revision History

03/2017 - Effective Date: 08/30/2016. Implementation Date: 04/04/2017. (TN 194) (CR9981)

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Additional Information

Other Versions
Title Version Effective Between
Gender Dysphoria and Gender Reassignment Surgery 1 08/30/2016 - N/A You are here