Transcend Legal logo

Health Insurance Medical Policies - Permanent Hair Removal


Below are excerpts from various health insurance medical policies that have explicit provisions detailing when electrolysis or laser hair removal is covered for transgender people.

The fact that an insurance company is listed here does not mean that your particular plan will follow these guidelines. You must look to your individual policy to determine if transgender care is covered or excluded. Only if it is covered will the policies below apply.

Policy: Sex Reassignment Surgery

Permanent Hair Removal

The use of hair removal procedures to treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure is considered medically necessary.

Policy: Transgender Services

Permanent Hair Removal

All of the following general criteria must be met for surgical gender affirming interventions for gender dysphoria to be considered for coverage:

A. Age at least 18 years (Note: age requirement will not be applied to mastectomy with documented provider determination of medical necessity of earlier intervention); and

B. Clinical records document that the patient has the capacity to make fully informed decisions and consent for intervention, and that any other mental health condition, if present, is adequately controlled; and

C. At least 2 licensed mental health professionals have diagnosed gender dysphoria, and recommend surgical intervention (Note: only 1 mental health professional referral is required for mastectomy); and

D. Documentation of continuous hormonal therapy for at least 12 months, unless there is a documented contraindication to hormonal therapy (Notes: hormonal therapy is not required prior to mastectomy; hormonal therapy for at least 6 months is required for endometrial ablation); and

E. Twelve months of living in a role that is congruent with the patient’s identity.

Any of the following procedures may be considered medically necessary when clinical information is submitted expressly documenting that the intervention would improve otherwise documented significant gender dysphoria, and all of Criteria II.A.-E. above are met: ... 2. Hair removal

Policy: Transgender Reassignment Surgery

Permanent Hair Removal

The use of hair removal procedures to treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure is considered medically necessary.

Policy: Treatments for Gender Dysphoria

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.

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Permanent Hair Removal

Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY.  These procedures may include the following:

• Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty);

Policy: Gender Affirming Services (Transgender Services)

Permanent Hair Removal

Electrolysis performed by a licensed dermatologist may be considered MEDICALLY NECESSARY for the removal of hair on a skin graft donor site prior to its use in genital gender affirmation surgery.

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Permanent Hair Removal

Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY.  These procedures may include the following:

• Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty)

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Permanent Hair Removal

Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY.  These procedures may include the following:

• Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty);

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Permanent Hair Removal

Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY.  These procedures may include the following:

• Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty);

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Permanent Hair Removal

Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY.  These procedures may include the following:

• Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty);

Policy: Gender Affirmation Surgeries

Permanent Hair Removal

Electrolysis and/or laser ablation treatments for hair removal performed by a licensed and qualified treating provider may be considered medically necessary when it is part of the standard pre-operative preparation for genital affirming genital reconstruction/affirmation surgery(ies). Examples include perineal hair removal prior to vaginoplasty and the removal of hair on a skin graft for its use in gender affirming genital reconstruction surgery but must be approved by a Plan Medical Director (e.g., hair removal on skin graft donor site prior to its use for vaginoplasty with MtF members or hair removal on skin graft donor site prior to its use for phalloplasty for FtM members). Plan prior authorization is required to determine the medical necessity of hair removal (by verifying indication for hair removal) and to coordinate coverage for the member (since hair removal is generally considered cosmetic for other indications).

Policy: Gender Affirming Interventions for Gender Dysphoria

Permanent Hair Removal

Any of the following procedures may be considered medically necessary when clinical information is submitted expressly documenting that the intervention would improve otherwise documented significant gender dysphoria, and all of Criteria II.A. above are met:

Hair removal

Policy: Gender Reassignment Services

Permanent Hair Removal

Other surgeries for assisting in body feminization or body masculinization are generally labeled cosmetic as they provide no significant improvement in physiologic function. However, these surgeries can be considered medically necessary depending on the unique clinical situation of a given patient’s condition. These surgeries include but are not limited to: ...

  • Hair removal via electrolysis, laser, and waxing/Hair transplantation
Policy: Gender Affirming/Reassignment Surgery — New York

Permanent Hair Removal

Genital electrolysis is not considered a surgical procedure, but is performed in conjunction with genital surgery (i.e., when required for vaginoplasty or phalloplasty)

Coverage is not available for any surgeries, services or procedures that are purely cosmetic (i.e., when performed solely to enhance appearance, but not to medically treat the underlying gender dysphoria). The following surgery, services and procedures will be reviewed on a case by case basis. It is expected that the clinical rationale for each requested procedure is specifically documented in the letter of medical necessity from the treating physician: ... Electrolysis (unless required for vaginoplasty or phalloplasty)

Policy: Transgender Health Services

Permanent Hair Removal

  • Electrolysis or laser hair removal pre-operatively for genital reconstructive procedures (i.e. Clitoroplasty, Colovaginoplasty, Labiaplasty, Orchiectomy, Penectomy, Vaginoplasty), for a maximum of six treatment sessions
  • Electrolysis or laser hair removal pre-operatively for genital reconstructive procedures (i.e. Colpectomy, Metoidioplasty, Phalloplasty, Scrotoplasty), for a maximum of six treatment sessions
Policy: Gender Reassignment Surgery

Permanent Hair Removal

Medically Necessary/Reconstructive Surgery

It is the policy of Health Net of California that each of the following procedures, when used specifically to improve the appearance of an individual undergoing gender reassignment surgery or actively participating in a documented gender reassignment surgery treatment plan, must be evaluated to determine if it is medically necessary reconstructive surgery to create a normal appearance for the gender with which the member identifies. Prior to making a clinical determination of coverage, it may be necessary to consult with a qualified and licensed mental health professional and the treating surgeon.

  • Electrolysis*
  • Hair transplantation
  • Hair removal

The above section clarifies how the plan administers benefits in accordance with the WPATH, SOC, Version 7. Provided a patient has been properly diagnosed with gender dysphoria or GID by a mental health professional or other provider type with appropriate training in behavioral health and competencies to conduct an assessment of gender dysphoria or GID, particularly when functioning as part of a multidisciplinary specialty team that provides access to feminizing/masculinizing hormone therapy, certain options for social support and changes in gender expression are considered to help alleviate gender dysphoria or GID.

For example, with respect to hair removal through electrolysis, laser treatment, or waxing, the WPATH “Statement of Medical Necessity for Electrolysis” (July 15, 2016) clarifies that patients with the same condition do not always respond to, or thrive, following the application of identical treatments. Treatment must be individualized, such as with electrolysis, and medical necessity should be determined according to the judgment of a qualified mental health professional and the referring physician.

The documentation to support the medical necessity for hair removal should include all three essential elements:

  • A properly trained (in behavioral health) and competent (in assessment of gender dysphoria) professional has diagnosed the member with gender dysphoria or GID.
  • The individual has completed 3 years of feminizing hormonal therapy.
  • The medical necessity for electrolysis has been determined according to the judgment of a qualified mental health professional and the referring physician.

If any element remains to be satisfied before medical necessity can be determined, the individual should be directed to an appropriate network participating provider for consultation or treatment.

Policy: Gender Identity Services

Permanent Hair Removal

Pre-surgical electrolysis for the removal of hair on a skin graft prior to use in genital reassignment surgery is covered.

Policy: Treatment of Gender Dysphoria

Permanent Hair Removal

POTENTIALLY COSMETIC

The following procedures are considered potentially cosmetic services, unless medical necessity demonstrating a functional impairment can be identified. Services that are cosmetic are a benefit contract exclusion for all products of the Company, and therefore, not eligible for reimbursement consideration. This is not an all-inclusive list, refer to any applicable medical policies. ...

  • Hair reconstruction (e.g. hair removal/electrolysis, hair transplantation, wigs)​​​​​​
Policy: Gender Dysphoria

Permanent Hair Removal

Please refer to UM Subcommittee Approved Guideline Hair Removal for hair reduction consultation and procedure authorization criteria.

Policy: Gender Reassignment Surgery

Permanent Hair Removal

Requirements for facial hair removal

KP Washington will cover facial hair removal for members with documented gender dysphoria and who are transfeminine. The area of treatment is limited to the face and throat and excludes eyebrows. Member can have either electrolysis or laser hair removal or both. The member must work with the KP Transgender Case Manager to determine the best provider for the service and arrange for either insurance billing or member reimbursement for services. The member needs to have active status at the time of the service. Pt needs to be age 18 or older or have parental consent.

Unless there are medical contraindications to therapy, patients should undergo feminizing hormone therapy aimed at decreasing androgen effects prior to hair removal to enhance efficacy and prevent additional/recurrent terminal hair growth. Adequate androgen blockade can be demonstrated by ONE of the following:

a. 6 months or longer of medical therapy aimed at decreasing androgen production or effects (for example, spironolactone/ GNRH agonists/ finasteride with or without estrogen) OR

b. Serum testosterone (total) in the normal female range (<100mg/dL) OR

c. History of prior gonadectomy

Note: Patients who have not had gender reassignment surgery (gonadectomy or vaginoplasty) should continue hormone/anti-androgen therapy unless contraindicated during and after hair removal to prevent recurrence.

Policy: Transgender Surgery

Permanent Hair Removal

Male-to-Female (MtF): Tracheal Shave and facial hair removal as well as surgical area hair removal by electrolysis or laser are covered when referred by a Gender Pathways provider.

Policy: Gender Reassignment Surgery

Permanent Hair Removal

Hair removal procedures (including electrolysis) may be considered medically necessary to treat tissue donor sites prior to phalloplasty or vaginoplasty.

Policy: Gender Reassignment Surgery

Permanent Hair Removal

The following adjunct procedures are considered medically necessary if the specific criteria is met for the procedure requested: Hair removal for surgical reconstruction (i.e. genital hair removal) that meets ALL of the following criteria:

  1. Hair removal for surgical reconstruction (i.e. genital hair removal) that meets ALL of the following criteria:
    1. Requested hair removal is prior to male to female genital surgery involving hair-bearing flabs associated with vaginoplasty due to 1 or more of the following:
      1. Skin area will be brought into contact with urine (used to construct a neourethra)
      2. Skin area to be moved to reside within a partially closed cavity within the body (e.g. used to line the neovagina)
  2. Request is NOT for hair-bearing skin that remains outside of the body after gender reassignment surgery as that does not need to be removed and will NOT be covered
  3. Hair removal will involve 1 or more of the following modalities which may take up to a year prior to surgery:
    1. Electrolysis
    2. Laser hair removal
  4. Request is NOT for hair removal for cosmetic reasons as that is NOT a covered benefit
  5. Patient meets criteria for genital surgery in section V.
Policy: Gender Reassignment Surgery

Permanent Hair Removal

Hair removal procedures (including electrolysis) may be considered medically necessary to treat tissue donor sites prior to phalloplasty or vaginoplasty.

Policy: Gender Affirming Interventions for Gender Dysphoria

Permanent Hair Removal

Any of the following procedures may be considered medically necessary when clinical information is submitted expressly documenting that the intervention would improve otherwise documented significant gender dysphoria, and all of

Criteria II.A.-E. above are met:

2. Hair removal

Policy: Sex Reassignment Surgery

Permanent Hair Removal

The use of hair removal procedures to treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure is considered medically necessary.

Policy: Gender Affirming Interventions for Gender Dysphoria: Clinical Criteria and Poli…

Permanent Hair Removal

Genital electrolysis and laser hair removal as required as part of the genital surgery is covered with prior authorization and is limited to the genitals and, if applicable, the graft site, as required for genital surgery. Electrolysis and laser hair removal not meeting these guidelines and the guidelines for Surgical Treatments of Gender Dysphoria outlined in the Gender Affirming Interventions for Gender Dysphoria Criteria and Policy is not covered.

Policy: Gender Dysphoria Treatment (Community Plan)

Permanent Hair Removal

Laser or electrolysis hair removal in advance of genital reconstruction prescribed by a physician for the treatment of gender dysphoria

Policy: Gender Dysphoria Treatment (Commercial Plans)

Permanent Hair Removal

Laser or electrolysis hair removal in advance of genital reconstruction prescribed by a physician for the treatment of gender dysphoria

Policy: Gender Dysphoria Treatment

Permanent Hair Removal

Laser or electrolysis hair removal in advance of genital reconstruction prescribed by a physician for the treatment of gender dysphoria

Policy: Gender Dysphoria (Gender Identity Disorder) Treatment

Permanent Hair Removal

Surgical treatment for Gender Dysphoria is covered when the Eligibility Qualifications for Surgery are met:

4. Hair Removal: Hair removal related to genital reconstruction (e.g. electrolysis or laser) when part of a complete care plan and ordered by a physician.

Policy: Gender Dysphoria Treatment Excluding California

Permanent Hair Removal

Laser or electrolysis hair removal in advance of genital reconstruction prescribed by a physician for the treatment of gender dysphoria

Policy: Gender Dysphoria (Gender Identity Disorder) Treatment

Permanent Hair Removal

Coverage is available for medical, behavioral or pharmacological treatment that is Medically Necessary for Gender Dysphoria. UnitedHealthcare does not exclude or deny covered health care benefits based on associated diagnosis of Gender Dysphoria, or otherwise discriminate against the member on the basis that treatment is for Gender Dysphoria.

Policy: Gender Dysphoria (Gender Identity Disorder) Treatment

Permanent Hair Removal

Coverage is available for medical, behavioral or pharmacological treatment that is Medically Necessary for Gender Dysphoria. UnitedHealthcare does not exclude or deny covered health care benefits based on associated diagnosis of Gender Dysphoria, or otherwise discriminate against the member on the basis that treatment is for Gender Dysphoria.

Policy: Gender Confirmation

Permanent Hair Removal

Hair removal is only considered medically necessary for any skin used to build a urethra or vagina. This is considered part of the genital surgery and will not be paid separately unless:

  • The surgeon documents why they are unable to oversee or perform the procedure themselves; and
  • The identified electrolysis provider must be able to perform ‘true needle electrolysis’, is certified in electrology, be an active member of the American Electrology Association (AEA), and holds an active Cosmetology License in Pennsylvania; and
  • The procedure will be for permanent hair removal on skin used to build a urethra or vagina only.
Policy: Gender Reassignment Surgery

Permanent Hair Removal

Hair removal procedures (including electrolysis) may be considered medically necessary to treat tissue donor sites prior to phalloplasty or vaginoplasty.