Clinical Policy: Gender-Affirming Procedures
Defines medical necessity criteria, covered procedures, and coding implications for gender-affirming medical and surgical treatments (GAMST) when included in a member/enrollee's benefit plan for Ambetter Nevada.
Criteria updated to incorporate WPATH Standards of Care version 8 (SOC-8).
Updated verbiage in Criteria IV to state that procedures used solely to improve appearance and unrelated to gender expression are not medically necessary and removed the list of procedures considered cosmetic.
Added 19318 to the list of CPT codes that may be considered part of gender-affirming procedures.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.