Gender Dysphoria Treatment
Medical policy governing coverage and medical necessity criteria for surgical and adjunct treatments for Gender Dysphoria for applicable UnitedHealthcare Commercial and Individual Exchange plans; describes required documentation, provider qualifications, and lists covered and cosmetic/excluded procedures.
This Medical Policy does not apply to the states of Florida and New Mexico; refer to the member specific benefit plan document.
Coverage criteria wording changed to require documentation that the individual meets all of the listed criteria for surgical treatment.
Revised coverage criteria for breast surgery to require individuals must be at least 18 years of age (removed language allowing consideration within one calendar year of turning 18).
Updated examples of ancillary procedures considered cosmetic and not medically necessary; added clavicular shortening and rib reconstruction, and broadened some procedure labels (e.g., 'facial bone remodeling').
Added language for Fully-Insured Group Policies in New York Only to require application of WPATH version 8 consistent utilization review criteria.
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.