I read this however that seems pretty old to be dated December 2013 / 13
Surgical Treatment of Gender Dysphoria
•
Pre-Certification/Pre-Authorization: Yes.
•
Criteria for breast and genital surgery have not changed. The diagnostic criteria for gender dysphoria have been updated
as follows:
•
Criteria for All Surgical Treatment
Surgical treatment of gender dysphoria may be considered MEDICALLY NECESSARY when all of the following criteria
have been met. These criteria are based on the Standards of Care for the Health of Transsexual, Transgender, and Gender
Nonconforming People, from the World Professional Association for Transgender Health.
A.
A comprehensive diagnostic evaluation has been completed by a psychiatrist, a clinical psychologist, or other licensed
mental health professional who
1.
Is experienced in the evaluation and treatment of gender dysphoria; and
2.
Has competence in the diagnosis of gender nonconforming identities and expressions, as well as in diagnosing
possible comorbid disorders such as psychotic disorders, personality disorders, and substance related disorders,
3.
Meets the Minnesota Department of Human Services qualifications for a mental health professional, as set forth in
Minn.Stat.245.4871, subds.26 and 27 (2011) and Minn.Stat.245.462, subds. 17 and 18 (2011).
Note:
If the level of competence of the evaluating or treating mental health professional is uncertain, the health plan will
seek a second opinion from a known expert in the diagnosis and treatment of gender dysphoria.
AND
Medical and Behavioral Health Policy Update
December 2013 / 14
Medical and Behavioral Health Policy Update
B.
Based on the comprehensive evaluation, the individual meets the diagnostic criteria for gender dysphoria in
adolescents and adults per the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM- 5):
1.
A marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months'
duration as manifested by at least two of the following:
a.
A marked incongruence between one's experienced/expressed gender and primary and/or secondary sex
characteristics.
b.
A strong desire to be rid of one's primary and/or secondary sex characteristics because of a marked
incongruence with one's experienced/expressed gender.
c.
A strong desire for the primary and/or secondary sex characteristics of the other gender.
d.
A strong desire to be the other gender (or some alternative gender different from one's assigned gender).
e.
A strong desire to be treated as the other gender (or some alternative gender different from one's assigned
gender).
f.
A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative
gender different from one's assigned gender).
AND
2.
The condition is associated with clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
