Blue Cross Blue Shield of Arizona

Policy Issued In
Arizona
Last Update
Breast Reconstruction

If benefit coverage for gender dysphoria treatment is available, the following surgical procedures are considered eligible for coverage: Initial breast augmentation (implants/lipofilling) with documentation of ALL of the following:

  • One referral from qualified mental health professional
  • Persistent, well-documented gender dysphoria
  • Capacity to make a fully informed decision and to give consent for treatment
  • Age of majority in a given country (if younger, follow the SOC for children and adolescents)
  • If significant medical or mental health concerns are present, they must be reasonably well controlled

Although not an explicit criterion, feminizing hormone therapy (minimum 12 months) prior to breast augmentation surgery is recommended. The purpose is to maximize breast growth in order to obtain better surgical (aesthetic) results.

Permanent Hair Removal

If benefit coverage for gender dysphoria treatment is available, permanent removal of genital hair with electrolysis in preparation for metoidioplasty, phalloplasty, scrotoplasty and urethroplasty is considered eligible for coverage.

If benefit coverage for gender dysphoria treatment is available, permanent removal of genital hair with electrolysis for all other indications not previously listed or if above criteria not met is considered cosmetic, not eligible for coverage and not medically necessary. See page 10 for list of other hair procedures.

If benefit coverage for gender dysphoria treatment is available, permanent removal of genital hair with electrolysis in preparation for clitoroplasty, penectomy, urethroplasty, vaginoplasty and vulvoplasty is considered eligible for coverage.

If benefit coverage for gender dysphoria treatment is not available, permanent removal of genital hair with electrolysis is considered a benefit plan exclusion and not eligible for coverage.

Youth Services

Hormone Therapy for Adolescents: Endocrine Society Clinical Practice Guidelines for endocrine treatment of transsexual persons state that adolescents are eligible and ready for gonadotropin-releasing hormone (GnRH) therapy for suppression of puberty if they:

  1. Fulfill DSM IV-TR or ICD-10 criteria for gender identity disorder (GID) or transsexualism
  2. Have experienced puberty to at least Tanner stage 2
  3. Have (early) pubertal changes that have resulted in an increase of their gender dysphoria
  4. Do not suffer from psychiatric comorbidity that interferes with the diagnostic work-up or treatment
  5. Have adequate psychological and social support during treatment
  6. Demonstrate knowledge and understanding of the expected outcomes of GnRH analog treatment, cross-sex hormone treatment, and sex reassignment surgery, as well as the medical and the social risks and benefits of sex reassignment