CurrentBlue Cross Blue Shield - South DakotaPolicy 02.01.64

Gender Affirming Services

This policy governs the medical necessity, prior approval, and coverage stance for gender-affirming medical and surgical treatments (adults and adolescents) for members of Blue Cross Blue Shield - South Dakota, including documentation requirements and which procedures are considered cosmetic/non-covered.

Policy Summary

PayerBlue Cross Blue Shield - South Dakota

PolicyGender Affirming Services

Policy CodePolicy 02.01.64

Change TypeInterim review / revisions (per policy history)

Effective DateMay 2022

Next Review Date

Key ActionObtain prior approval using the Wellmark Authorization Table and InterQual criteria and submit required referral/assessment documentation that documents DSM gender dysphoria diagnosis, WPATH SOC-8 standards met, and necessary multidisciplinary assessment as applicable.

SourceLink

WPATH SOC-8 (2022)Referenced guideline

Multiple Hayes reviewsEvolving evidence assessments summarized

predominantly poor/very lowOverall evidence quality reported for many surgical/ancillary procedures

72–100%Reported patient satisfaction ranges in studies

2 populations

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