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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

When the criteria in II.A. above are met or have been met, the following procedures may be considered medically necessary when clinical information is submitted expressly documenting that the particular requested procedure would improve otherwise documented significant gender dysphoria: ... 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: 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 sex reassignment 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. (See related medical policies below for information regarding related procedures or services because other exclusions may apply). 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. (See related medical policies below for information regarding related procedures or services because other exclusions may apply). 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. (See related medical policies below for information regarding related procedures or services because other exclusions may apply). These procedures may include the following:

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

Policy: Gender Reassignment Surgery

Permanent Hair Removal

Electrolysis and/or laser ablation treatments for hair removal performed by a licensed dermatologist or treating provider may be considered medically necessary for the removal of hair on a skin graft for its use in genital sex reassignment 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)

Policy: Transgender Services

Permanent Hair Removal

The following procedures may be considered medically necessary when clinical information is submitted expressly documenting that the particular requested procedure would 
improve otherwise documented significant gender dysphoria: ... Hair removal
 

Policy: Gender Affirming/Reassignment Surgery — Connecticut

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)

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), as per Paragraph 5, 18 NYCRR 505.2(l), of the NYS Register. The following surgery, services and procedures will be presumed to be cosmetic and will not be covered, unless justification of medical necessity is provided and prior approval is received:

Electrolysis (unless required for vaginoplasty or phalloplasty)

Policy: Gender Reassignment Surgery

Permanent Hair Removal

Medically Necessary/Reconstructive Surgery

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: 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

Hair Reduction Procedure Consultation:

a. Surgical site hair reduction either by laser or electrolysis is covered as part of the preparation of gender-affirming surgery. Requests require:

i. Completion of the surgical consultation.

ii. Surgeon indicates Member is an appropriate surgical candidate and that hair removal is a requirement in preparation of the surgery.

b. Facial Hair Reduction requests require:

i. 12 continuous months of hormone therapy, unless a medical contraindication is documented.

ii. Member has lived in preferred gender for 12 continuous months.

iii. List alternative methods of hair reduction and their results.

iv. Informed consent.

v. A Medical Evaluation Form is to be completed (see Attachment B).

Alternatively, the Provider may submit the same content in the clinical documentation.

vi. The Provider or Therapist Documentation Form for Evaluation for Transgender Surgery is to be completed (see Attachment C).

Alternatively, a letter from the Provider addressing the same content as Attachment C is acceptable.

a. The form/letter must evaluate gender dysphoria related to the presence of facial hair, AND

b. Address how the presence of facial hair impairs function in relation to activities of daily living, AND

c. Address how facial hair removal will improve quality of life and daily function.

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

Coverage of facial hair removal, by electrolysis or laser, will be determined in accordance with the member’s benefits 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

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. 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 GAS 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: Transgender Services

Permanent Hair Removal

The Uniform Medical Plan covers the following procedures with prior authorization that meet medical necessity criteria: ... 9. Genital electrolysis as required as part of the genital surgery, including electrolysis of the graft site, as required for genital surgery

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: Uniform Medical Plan (UMP ) Transgender Services

Permanent Hair Removal

Genital electrolysis as required as part of the genital surgery, including electrolysis of the graft site, as required for genital surgery