We have received many requests from patients for documentation to apply for reimbursement from their insurance carrier for some or all of their transgender procedure costs. While our practice does not accept insurance for the transgender procedures, nor are we contracted with any insurance carrier as a provider, we will provide you with a letter describing the procedure(s) and also provide some acceptable CPT codes for insurance reimbursement. The letter will be provided after surgery only, and will contain the details describing your journey, your challenges, the medical and psychological appropriateness of your transition, and your procedure and the current procedural terminology. Of course each letter will be customize to the details and specifics of your case.
This is an example of an insurance letter for Top Surgery:
“This procedure is commonly known as “FTM Top Surgery” or “bilateral double incision method with free nipple grafts”. This is a common procedure of gender reassignment for patients who identify as female to male transgender. The diagnosis code applicable to the diagnosis of gender dysphoria is ICD-9 code 302.85. The procedure involves removing about 95% of the breast tissue by a modified simple mastectomy approach. The CPT Code used typically can be preferably 19303 (simple complete) or if necessary 19304 (subcutaneous mastectomy) with a modifier 52 for “reduced services”. Along with this procedure, the nipple and areolar complex is reconstructed using the patient’s own tissue. The CPT Code used typically is 19350 (nipple areolar reconstruction). These procedures are performed bilaterally, and usually done on an outpatient basis.”
We provide thorough documentation substantiating your transition and its medical and psychological appropriateness and why and how it should be covered by your insurance. We advocate for you. We word our letters as strongly and ethically as possible. However, we are not able to communicate with your insurance carrier or negotiate/mediate with them since we are out-of-network with all insurance carriers. If they send us any payment, we forward that on to you. Our practice is committed to offering you the best care and we are committed to keeping the cost of your medical care low. We hope this will help you with your transition and help you with the rising costs of medical care that all patients and physicians are facing.
Many of our patients will have a health savings account (HSA) or flexible savings account (FSA). These can be utilized for procedures and several of our patients have had success with this payment arrangement.