Gender Confirming Surgeries for Trans Women

Listed are some of the surgeries that may be medically necessary or desired for trans women and gender-diverse people assigned male at birth. Some trans women 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.

We strongly urge you to follow the links to additional resources for more comprehensive information about surgeries, care, risks and costs.

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

Orchiectomy (removal of the testes, i.e. castration)

Orchiectomy (also named orchidectomy, and sometimes shortened as orchi) is a surgical procedure in which one or both testicles are removed.

Vaginoplasty (creation of a vagina)

Vaginoplasty is a surgical procedure that essentially converts penile and scrotal tissues into a vagina, clitoris, and labia.

Labiaplasty (creation of labia; usually refers to creation of clitoral hood as well)

Labiaplasty is usually the second stage of a two-stage vaginoplasty operation, where labiaplastic techniques are applied to create labia minora and a clitoral hood.

Breast augmentation

Breast implants, or augmentation mammaplasty, is a procedure some trans women undergo in order to supplement development they had with hormones.

Feminization laryngoplasty

Surgeries on the vocal cords to make the voice’s pitch higher. The procedure is designed to remodel the voice box, to make it smaller and the vocal cords shorter, in an attempt to raise the comfortable speaking pitch.

Facial feminization surgeries (FFS) of various sorts

  • Hairline changes
  • Brow lift
  • Rhinoplasty (reshaping of the nose)
  • Chin and jaw reshaping
  • Various procedures on the lips
  • Flattening and smoothing of the brow ridge
  • Tracheal shave (reduction of Adam’s apple)
  • Facelift

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 Women – Common Medical Procedural Codes

HCPCS Codes Description
  17β-estradiol
J1380 Injection, estradiol valerate, up to 10 mg
J1390 Injection, estradiol valerate, up to 20 mg
J0970 Injection, estradiol valerate, up to 40 mg
  estrogen patch 
  Spironolactone
CPT Codes Description
55970 Intersex surgery; male to female
Also combinations of individual procedures billed separately, including but not limited to
19324 Mammaplasty, augmentation; without prosthetic implant
19325 Mammaplasty, augmentation; with prosthetic implant
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
54120 Amputation of penis; partial
54125 Amputation of penis; complete
54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach
54690 Laparoscopy, surgical; orchiectomy
55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed
56800 Plastic repair of introitus
56805 Clitoroplasty for intersex state
56810 perineoplasty, repair of perineum, nonobstetric [separate procedure]
57291 Construction of artificial vagina; without graft
57292 Construction of artificial vagina; with graft
57295 Revision (including removal) of prosthetic vaginal graft; vaginal approach
57296 Revision (including removal) of prosthetic vaginal graft; open abdominal approach
57335 Vaginoplasty for intersex state
57426 Revision (including removal) of prosthetic vaginal graft, laparoscopic approach
58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);
57426 Revision (including removal) of prosthetic vaginal graft, laparoscopic approach
58999 Unlisted procedure, female genital system (nonobstetrical)
31899 Trachea shave/reduction thyroid chondroplasty: reduction of the thyroid cartilage

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

Sources:

Comments are closed