Prior Auth Required

54401 - Gender affirming surgery – Female to Male , , , , , , , , , , , , , , , , , All

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceGender affirming surgery – Female to Male , , , , , , , , , , , , , , , , , All
Procedure / Service Description

Service Category Benefit/Description Codes Requiring Authorization Member Program* - Gender Affirming Surgery Gender affirming surgery – Male to Female 53430, 54125, 54520, 54690, 55866, 55970, 56800, 56805, 57291, 57292, 57295, 57296, 57335, 57426, 58999, 15772, 15773, All 19325, 31599, 17380, 17999 Gender affirming surgery – Female to Male 19303, 19302, 19300, 19318, 53420, 53425, 53430, 54400, 54401, 54405, 54660, 55175, 55180, 15200, 31599, 17380, 17999, All 55899, 55980, 56625, 57106, 57110, 58150, 58180, 58260, 58262, 58275, 58290, 58291, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58720

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.