Gender Confirming Surgeries for Trans Men

Listed are some of the surgeries that may be medically necessary or desired for trans men and gender-diverse people assigned female at birth. Some trans men undergo them all and some may undergo none or only some, either by choice or for health reasons. We strongly urge you to follow the links to additional resources for more comprehensive information about surgeries, care, risks and costs, and speak to your doctors regarding more complete information.

Brynn Tannehill on why gender-confirming surgeries are important to trans people:

Without GCS sexual functioning, self-esteem, body image, socioeconomic adjustment, family life, relationships, psychological status and general life satisfaction are all negatively affected. This is supported by the numerous studies (Murad M., 2010, DeCuypere, 2006, Kuiper M. 1988, Gorton 2011, Clements-Nolle K., 2006), which also consistently show that access to GCS reduces suicidality by a factor of three to six (between 67 percent and 84 percent). Eighty percent of transgender people contemplate suicide, and 41 percent of transgender people attempt it. Lack of access to care is in fact likely to kill many transgender people. If this was a type of cancer that was killing 41 percent of the people who developed it, and it was possible to reduce the mortality rate by similar percentages, there wouldn’t be any argument happening.

It doesn’t even have to be life or death to be medically necessary, though. A herniated disk won’t kill you, but it will wreck your quality of life. Similarly, this is why every major medical, psychological, psychiatric, and therapist organization in the U.S. has issued statements supporting the medical necessity of GCS. The court system is increasingly acknowledging this, with five Circuit Courts having ruled that withholding transgender specific health care from prisoners is a violation of the 8th Amendment, because it is medically necessary.

Types of Surgeries

Chest Reconstruction Surgery

Bilateral mastectomy
The double incision technique is effective for individuals with a medium to large amount of breast tissue (cup size C and above, often also recommended for cup size B). In this method, large incisions are made horizontally across each breast, usually below the nipple.

Keyhole/Peri-areolar incision
The keyhole and peri-areolar techniques are effective for individuals with small amounts of breast tissue (cup size A or smaller is ideal; sometimes recommended by certain surgeons for cup size B). They are both done via incisions around the areola (the area of darker skin around the nipple), though the techniques differ slightly.

Hudson’s Guide: FTM Chest Reconstruction Surgeries

Hysterectomy and Oophorectomy

Hysterectomy
Removal of the uterus. There are three main ways in which the uterus can be removed from the body: either through an incision in the abdomen, vaginally through an incision in the top of the vagina (sometimes assisted laparoscopically through small incisions in the abdomen), or through a combination of tissue removal through small incisions in the abdomen as well as through the vagina.

salpingo-oophorectomy
For trans men, this procedure will usually be performed at the same time as your hysterectomy. Because the risk of ovarian cancer remains if the fallopian tubes are left behind, both the ovaries and fallopian tubes are usually removed during this procedure.

Hudson’s Guide: FTM Hysterectomy and Oophorectomy

“Bottom” Surgery

Creation of a penis, usually accomplished (if accomplished at all) by one of two techniques:

Metoidioplasty
a procedure done on a clitoris that has been enlarged with the use of testosterone; it then resembles a cis man’s penis in appearance, though smaller than usual. The labia are joined together, with two prosthetic balls inserted within, to form a scrotum.

Phalloplasty
Phalloplasty involves the construction of a penis using donor skin from other areas of the body. Depending on the type of phalloplasty procedure, skin is typically taken from the abdomen, groin/leg, forearm, and/or side of the upper torso (latissimus dorsi area) and grafted onto the pubic area. Phalloplasty usually involves a urethral lengthening procedure so that the patient can urinate through the penis. Erections are usually achieved with either a malleable rod implanted permanently or inserted temporarily in the penis, or with an implanted pump device.

Hudson’s Guide: FTM Genital Reconstruction Surgery (GRS)

Codes Related to Gender Confirming Surgeries

These codes are related to diagnosis and billing, and normally patients don’t need to know these codes. They’re intended for insurance companies and health care providers to communicate with one another. But for trans people seeking services and trying to understand what medical coverage they may have for transition-related healthcare and surgeries, you may need to reference these codes when working with insurance companies to find out what care might be covered.

Diagnosis Codes

ICD-9-CM are a set of codes used by physicians, hospitals, and allied health workers to indicate diagnosis for all patient encounters. These are the codes that indicate that transition-related medical treatments are “medically necessary.” ICD-9 codes will be replaced by an equivalent ICD-10-CM code (or codes) when the United States transitions from ICD-9-CM to ICD-10-CM on October 1, 2015.

ICD-9 CM codes Description ICD-10-CM codes Description
302.50 Trans-sexualism ICD-10-CM F64.1  Gender dysphoria in adolescence and adulthood
302.51 Trans-sexualism, asexual.
302.52 Trans-sexual, homosexual.
302.53  Trans-sexual, heterosexual
302.85 Gender dysphoria in adolescents or adults
    ICD-10-CM F64.2 Gender dysphoria of childhood
    ICD-10-CM F64.8 Other gender dysphoria
    ICD-10-CM F64.9 Gender dysphoria, unspecified

CPT and HCSPCS Codes

Current Procedural Terminology (CPT) code is a five digit numeric code that is used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are approximately 7,800 CPT codesranging from 00100 through 99499.

The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as “hick picks”) is a set of health care procedure codes based on the American Medical Association’s Current Procedural Terminology (CPT).

Trans Men – Common Medical Procedural Codes

HCPCS Code Description
J1070 Injection, testosterone cypionate, UP TO 100 MG
J1080 Injection, testosterone cypionate, 1 cc, 200 mg
J3120 Injection, testosterone ENANTHATE, UP TO 100 MG
J3130 Injection, testosterone ENANTHATE, UP TO 200 MG
J3140 Injection, testosterone SUSPENSION, UP TO 50 MG
J3150 Injection, testosterone PROPIONATE, UP TO 100 MG
CPT Codes Description
55980 Intersex surgery; female to male
Also combinations of individual procedures billed separately, including but not limited to
19303 Mastectomy, simple, complete
19304 Mastectomy, subcutaneous
19350 nipple areolar reconstruction
53415 Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra
53420 Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage
53425 Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage
53430 Urethroplasty, reconstruction of female urethra
54400 Insertion of penile prosthesis; non-inflatable (semi-rigid)
54401 Insertion of penile prosthesis; inflatable (self-contained)
54405 Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir
54410 Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session
54411 Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue
54416 Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session
54417 Removal and replacement of a non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue
54660 Insertion of testicular prosthesis
55175 Scrotoplasty; simple
55180 Scrotoplasty; complicated
55899 Metoidioplasty
55899 Phalloplasty
56625 Vulvectomy, simple; complete
57106 Vaginectomy, partial removal of vaginal wall
57107 Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy)
57110 Vaginectomy, complete removal of vaginal wall;
57111 Vaginectomy, complete removal of vaginal wall
58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);
58180 Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)
58260 Vaginal hysterectomy, for uterus 250 grams or less;
58262 Vaginal hysterectomy, for uterus 250 grams or less; with removal of tube(s), and/or ovary(s)
58275 Vaginal hysterectomy, with total or partial vaginectomy
58290 Vaginal hysterectomy, for uterus greater than 250 grams;
58291 Vaginal hysterectomy, for uterus greater than 250 grams; with removal of tube(s), and/or ovary(s
58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less;
58542 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g;
58544 Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58550 Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 grams or less;
58552 Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 grams or less; with removal of tube(s), and/or ovary(s)
58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g
58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams; with removal of tube(s) and/or ovary(s)
58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
58572 aparoscopy, surgical, with total hysterectomy, for uterus 250 g or less
58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
58661 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure): with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy
58720 Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)
58940 Oophorectomy, partial or total, unilateral or bilateral

Procedures that are often considered cosmetic and therefore not covered under insurance

CPT Codes / HCPCS Codes Description
11950 – 11954 Subcutaneous injection of filling material (eg, collagen)
15775 Punch graft for hair transplant; 1 to 15 punch grafts
15776 Punch graft for hair transplant; more than 15 punch grafts
15780 Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)
15781 Dermabrasion; segmental, face
15782 Dermabrasion; regional, other than face
15783 Dermabrasion; superficial, any site, (eg, tattoo removal)
15787 Abrasion (lesion)
15788 – 15789 Chemical peel, facial
15792-15793 Chemical peel, nonfacial
15820 – 15823 Lower eyelid blepharoplasty, Upper eyelid blepharoplasty
15824 – 15828 Rhytidectomy – elimination of wrinkles from, or reshaping of, the face, by excising any excess skin and tightening the remainder
15830 – 15839 panniculectomy (tummy tuck), abodomen, thigh, leg, hip, buttock, arms, forearm, toher
15876 – 15879 Suction assisted lipectomy
17380 Electrolysis epilation for pilonidal sinus disease
19316 Mastopexy – breast lift
19318 Unilateral reduction mammaplasty
19324 – 19325 Mammaplasty, augmentation; without prosthetic implant
19340 immediate insertion of breast prosthesis
19342 delayed insertion of breast prosthesis
21120 – 21123 Genioplasty for cosmetic reasons
21125 – 21127 Facial implants for augmentation, Bony augmentation and osteoplasty
21208 – 21209 Bony augmentation and osteoplasty
21210 Graft, bone; nasal, maxillary, or malar areas (includes obtaining graft),
21270 Malar augmentation, prosthetic material
30400 – 30420 Rhinoplasty – primary – various types
30430 – 30450 Rhinoplasty – secondary – various
67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)
92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
92508 Treatment of speech, language, voice, communication, group of two or more individuals
Other CPT codes related to the CPB:
11980 insertion of subcutaneous pellet implant
90785 Psychology – Interactive Complexity
90832 – 90838 Individual psychotherapy
96372 therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular
HCPCS codes:
J1950 Injection, leuprolide acetate (for depot suspension), per 3.75 mg
J9217 Leuprolide acetate (for depot suspension), 7.5 mg
J9218 Leuprolide acetate, per 1 mg
J9219 Leuprolide acetate implant, 65 mg
HCPCS codes :
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
S9128 Speech therapy, in the home, per diem

cadeuses - male

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