Gender-affirming hormone treatment induces facial feminization in transwomen and masculinization in transmen: quantification by 3D scanning and patient-reported outcome measures. Insufficient consensus has been established to consider gonad and genital surgery for adolescents with gender dysphoria in accordance with generally accepted standards of medical practice. Can J Psychiatry. Access a full range of health services from ProHealth Care. Updated Discussion and References sections. CPT Only American Medical Association, ANC.00007 Cosmetic and Reconstructive Services: Skin Related, ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck, ANC.00009 Cosmetic and Reconstructive Services of the Trunk and Groin, CG-SURG-03 Blepharoplasty, Blepharoptosis Repair, and Brow Lift, CG-SURG-12 Penile Prosthesis Implantation, SURG.00023 Breast Procedures; including Reconstructive Surgery, Implants and Other Breast Procedures, Gender Affirming Surgery in Individuals Under the Age of 18, https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/90875286. Gender affirming voice modification surgery is considered reconstructive when all of the following criteria have been met: The following gender affirming surgical procedures are considered not medically necessary when one or more of the medical necessary or reconstructive criteria above have not been met: The following procedures, when requested alone or in combination with other procedures, are considered cosmetic and not medically necessary when applicable reconstructive criteria above have not been met, or when used to improve the gender specific appearance of an individual who has undergone or is planning to undergo gender affirming surgery, including, but not limited to, the following: A provider with experience treating adolescents with gender dysphoria may request further consideration of a gender affirming chest procedure case in an individual under 18 years old when they meet all other gender affirming chest procedure criteria above (including prior mental health evaluation) by contacting a Medical Director. } }); Curr Opin Pediatr. If the individual is diagnosed with severe psychiatric disorders and impaired reality testing (for example, psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder), an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated; Two referrals from qualified mental health professionals* who have independently assessed the individual. 1997; 36(7):872-880. With that in mind, some recommendations should be re-assessed in the context of U.S.-based medical and surgical settings. The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR) provides criteria for the diagnosis of gender dysphoria. Depending on your plan, you may first need to pay the providers A strong desire for the primary and /or secondary sex characteristics of the other gender. The onset of the anatomic effects (e.g., clitoral growth, vaginal mucosal atrophy) may begin early after the initiation of therapy, and the peak effect is expected at 12 years (TSjoen et al., 2019). Behavioral Health Subcommittee review. Prior authorization lookup tool - UniCare * Use the Prior Authorization tool within Availity. In 2021 Littman reported on a survey study of 100 subjects responding to a 115-question online survey who had transitioned and detransitioned medically, surgically, or both. Arch Sex Behav. 2010; 19(7):1019-24. Deleted not due to chromosomal abnormality from medically necessary criteria. Behavioral Health Subcommittee review. Top 10 UniCare Provider Specialties: Internist (2516 providers) Pediatrician (Kids / Children Specialist) (2067 providers) Psychiatrist (1297 providers) Family Doctor (1278 providers) Obstetrician / Gynecologist (OBGYN) (816 providers) Radiologist (626 providers) Cardiologist (Heart Specialist) (504 providers) Surgeon (487 providers) Contrary to Turban, external forces such as discrimination (23%), financial concerns (17%), and online sources (29%) were less prevalent reasons cited for detransitioning. . 2018. Whether your coverage has been with Tufts Health Plan or Harvard Pilgrim in the past, you are now enrolled in a new Harvard Pilgrim plan. Added text to the Background section regarding WPATH recommendations for the content of referral letters. Miller TJ, Wilson SC, Massie JP, et al. Find a Doctor | UniCare - Anthem MPTAC review. Clarified the NMN statement and Cosmetic and NMN statement. Male-to-female sex reassignment surgery using the combined technique leads to increased quality of life in a prospective study. Take a minute to meet these members of the ProHealth team. While some clients prefer in-person sessions because they offer a safe, neutral ground for the session to take place, for the widest range of therapist options, consider expanding your search to also include providers licensed in your state who offer telehealth, or therapy sessions via remote video call. For a complete and detailed description of benefits and Plan provisions, see your member handbook. Pages 511-520. Criteria requiring hormone therapy for individuals assigned as male at birth (unless there is a medical contraindication or documented intolerance) aims to allow the development of at least some breast tissue prior to the desired surgery. Gender affirming facial surgery in individuals with gender dysphoria is considered reconstructive when the procedure(s) is(are) intended to address a significant variation from normal appearance for the experienced gender. Available data demonstrates that the long-term use of hormone therapy does quantifiably femininize or masculinize facial features, thus extended use of hormone therapy prior to facial feminization may be warranted in some circumstances (Tebbens, 2019). Online therapy sessions are a convenient way to find a therapist near Muskego, Wisconsin without leaving the comfort of your home or office. J Sex Med. One study of 188 subjects undergoing gender affirming surgery found that dissatisfaction with surgery was highly associated with sexual preference, psychological co-morbidity, and poor pre-operative body image and satisfaction (Smith, 2005). (1 |)5.5. A systematic review of the psychological benefits of gender-affirming surgery. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Two separate letters, or one letter signed by both (for example, if practicing within the same clinic) are required. Breast development in transwomen after 1 year of cross-sex hormone therapy: results of a prospective multicenter study. Edit your unicare appeal form online Type text, add images, blackout confidential details, add comments, highlights and more. When multiple procedures are requested, each procedure should be considered separately as some procedures may be cosmetic and others may be reconstructive. For many people, the most affordable way to seek mental health services is to look for a provider who is in-network with your insurance. Ascha M, Sasson DC, Sood R, et al. Deleted criteria requiring Demonstrable knowledge of the required length of hospitalizations, likely complications, and post-surgical rehabilitation requirements of various surgical approaches. visit the Unicare website or call the number on the back of your insurance card and ask about your coverage Welcome to UniCare | UniCare State Indemnity Plan The evaluation process should involve professionals who are adequately trained and experienced in working with adolescent individuals with potential gender dysphoria, and that they work closely with the individual and their parent(s) or legal guardians. Find a Medical Provider (For non-Medicare members only) Find a Behavioral Health Provider (For all members) Find Care by Your Plan Not sure which plan you're in? A majority (58%) of respondents stated that their dysphoria was related to trauma or a mental health condition, and 51% stated that transition delayed their receiving proper care for their underlying condition. Updated content related to new DSM-5-TR and WPATH SOC8 criteria and recommendations. Last Updated 07/21/2023 Similar findings were reported earlier by Schlatterer (1996). J Psychol. NOTE: Reversal of a prior gender affirming surgery procedure is considered gender affirming surgery and the medical necessity criteria below apply. PLUS Tier 1 Hospitals Addison . Quality of life and sexual health after sex reassignment surgery in transsexual men. Send this form with all pertinent medical documentation (see list of examples on following page) to: Reversal surgery in regretful male-to-female transsexuals after sex reassignment surgery. Created separate criteria sets for gonad and reproductive organ procedures and for external genital procedures in alignment with the WPATH SOC7. Plast Reconstr Surg Glob Open. A marked incongruence between ones experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least six of the following (one of which must be Criterion A1): A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender, different from ones assigned gender). Unicare is a common health insurance in Wisconsin, and individuals who have Unicare may wish to find therapists who are in-network with their health insurance. Breast augmentation in male-to-female transgender patients: Technical considerations and outcomes. Br J Psychiatry. Or call UniCare Customer Service at 800-442-9300. Important information for Medicare Supplement insurance customers: doctors or other providers that accept Medicare Assignment will accept the Medicare-approved amount as payment in full on all Medicare claims, and only bill for any deductible, copay or . Biomed Res Int. Hair removal (for example, electrolysis or laser) and hairplasty. We recommend that, where indicated, GnRH analogues are used to suppress pubertal hormones. Yes, most Muskego, Wisconsin health insurance carriers provide mental health benefits that cover therapy. More than half of respondents were from the U.S. (51%), 32% were from Europe, 6% were from Canada, and the remaining were from Australia (5%). Some individuals with gender dysphoria may be dissatisfied with the pitch or other aspects of their voice, which may be considered not in alignment with their experienced gender. Technical Help Desk: 1-866-755-2680 Pharmacy Help Desk: 1-888-809-6084 Individuals & Families Customer Service For membership inquiries please contact us by email at: Individual.Membership@Unicare.com. Updated Discussion and References sections. Gender dysphoria in Adolescents and Adults*. In order to see a therapist, they must be licensed to provide online sessions to clients living in your state. Updated Discussion, Coding, and References sections. The selection of appropriate procedures should be based on the needs of the individual as required for treatment for gender dysphoria. J Sex Med. While the WPATH SOC8 recommends only 6 months of GAHT, the international nature of the document should be considered, and that the use of 12 months of GAHT in the U.S. clinical setting is not unreasonable or unattainable. J Sex Med. PDF Reconsideration / Formal Appeal Form - Independent Care Health Plan Start your search for an appointment with a therapist in Muskego, Wisconsin on Zencare. Commonly utilized procedures may include the following: Other less common procedures listed by WPATH SOC8, such as blepharoplasty, liposuction, brow lift, reduction, or enhancement, may be used to alter facial appearance, when existing facial appearance demonstrates significant variation from normal appearance for the experienced gender. If you have an HMO, EPO, or Medicaid/Medicare plan, you likely cannot receive reimbursement, and would be responsible for the full out-of-network session fee. Or, if you needhelp finding the right provider for you and your family, call262-928-2745to talk with one of our referral specialists. The phrase cosmetic was clarified to read cosmetic and not medically necessary. The authors conducted an inverse probability of treatment weighting (IPTW) model analysis to estimate the association of the surgical procedure with outcomes. Attn: Grievance & Appeals Department UniCare Health Plan of West Virginia, Inc. P.O. Gender affirming pelvic and gonadal procedures have been shown in many studies to provide significant functional improvement in multiple areas (Almazan, 2021; Becker, 2018; Butler, 2019; Cardoso da Silva, 2016; Castellano, 2015; De Cuypere, 2005; de Vries, 2014; Djordjevic, 2009; Guss, 2015; Hage, 2006; Jellestad, 2018; Lawrence, 2006; Miller, 2019; Murad, 2010; Olson-Kennedy, 2018; Owen-Smith, 2018; Papadopulos, 2015; Simbar, 2018; Terrier, 2014; Tucker, 2018; van de Grift, 2017; Weigert, 2013; Wernick, 2019; Wierckx, 2011). Behavioral Health Subcommittee review. Provider | UniCare Health Plan of West Virginia, Inc. The sample population was overwhelmingly white (90%) and female (69%). 2014; 134(4):696-704. Vandenbussche E. Detransition-related needs and support: a cross-sectional online survey. Updated Coding and Rationale sections. Patient satisfaction after aesthetic chondrolaryngoplasty. Reformatted Coding section and added codes 54400, 54401, 54405, 55899, C1813, C2622, L8699. Subjects lost to follow-up had significantly higher median scores on the Chest Dysphoria (CDM) tool and Body Image Scale (BIS), indicating a higher degree of chest-related dysphoria. Find a therapist near you in Muskego, Wisconsin on Zencare. Share your form with others Send unicare appeal form via email, link, or fax. 'AttachPosition': 'after', View Dental Provider Resources Life & Disability Find Care | UniCare State Indemnity Plan - Anthem PDF Plan Benefits - Medicare Extension - Anthem A total of 2242 respondents indicated a history of detransition, which the survey defined as a process through which a person discontinues some or all aspects of gender affirmation. Roughly half of the respondents (55.1%) indicated they had received gender affirming hormone therapy, and 16.5% had obtained one or more gender affirming surgical procedures. Gender affirming facial surgery is considered reconstructive when all of the following criteria have been met: See Discussion section for a list of procedures included in this group of procedures. In countries that have not implemented the latest ICD, other taxonomies may be used although efforts should be undertaken to utilize the latest ICD as soon as practicable.6.12.b- The experience of gender diversity/incongruence is marked and sustained over time.6.12.c- The adolescent demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.6.12.d- The adolescents mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed.6.12.e- The adolescent has been informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility, and these have been discussed in the context of the adolescents stage of pubertal development.6.12.f- The adolescent has reached Tanner stage 2 of puberty for pubertal suppression to be initiated.6.12.g- The adolescent had at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated. Procedures to address postoperative complications of a prior gender affirming surgery (for example, scarring, stenosis, infection, etc.) Find a therapist who sees clients after hours on Zencare. Such procedures may include the following, when one or more of the medical necessary or reconstructive criteria above have not been met: Other procedures are not generally intended to address anatomy directly related to symptoms of gender dysphoria, including the following: Please refer to applicable documents for procedures for individuals with gender dysphoria that are not related to gender affirming surgery. Updated Coding, Rationale and Discussion section. While adaptable, they offer standards for promoting optimal health care and for guiding the treatment of people experiencing gender incongruence. Furthermore, they failed to fulfill the complete diagnostic criteria for gender dysphoria. Updated Reference sections. To look for hospitals, go to unicarestateplan.com and, under the Quick Links tab on the Members page, select Look for health care providers. The WPATH SOC8 provides the following recommendations below for the treatment of adults requesting surgical treatment for gender dysphoria, which are conceptually aligned with criteria provided above in the Clinical Indications section. 2017; 79(7):815-823. Clarified hair removal MN statement. Procedures primarily intended to preserve or improve appearance (that is: independent of any gender-defining feature or overall gender appearance) are considered cosmetic. We suggest that adolescents who meet diagnostic criteria for GD/gender incongruence, fulfill criteria for treatment, and are requesting treatment should initially undergo treatment to suppress pubertal development. Revised gender dysphoria criteria in all MN statements. Turban JL, Loo SS, Almazan AN, Keuroghlian AS. Given the complexity of the evaluation process, a multidisciplinary approach to the evaluation and management of an individual seeking gender affirming surgical treatment is considered in accordance with generally accepted standards of medical practice. 'DefaultSettings': { In late 2017, the Endocrine Society released a clinical practice guideline for the endocrine treatment of gender-dysphoric/gender-incongruent persons (Hembree, 2017).

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