Does Medicare Cover Facial Feminization Surgery?

If you have facial feminization surgery, you’re taking your masculine facial features and transforming them to help you present a feminine form. The objective of this process is to soften your facial features that may be commonly considered to be masculine. Bone structure and nasal shape are the two main areas facial feminization surgery focuses on. It may also alter the soft tissue in your neck or face. Medicare recipients wonder if their benefits will cover the cost. 

Medicare Benefits Solutions

Jan 28, 2021

 3 minutes read

Surgery and Medicare benefits

Before you try to schedule any type of surgery, you should sit down with your doctor and find out if it’s going to be an outpatient or inpatient procedure. If the surgery is on an outpatient basis, you could choose to have it at an ambulatory surgical center instead of a hospital’s outpatient facility. Medicare Part A is responsible for paying for any inpatient care you have while formally admitted into the hospital or skilled nursing facility. Home health and hospice services are also covered under Medicare Part A benefits. 

Medicare Part B is medical insurance, and this will include any outpatient physician services that Medicare deems medically necessary. It also includes home health, outpatient care, mental health services, and durable medical equipment. Both Medicare Part A and Part B have a yearly deductible you have to meet before they pay for anything. In 2021, the Part A deductible is $1,484, and the Part B deductible is $203.

Does Medicare coverage extend to facial feminization surgery?

If Medicare decides that your facial feminization surgery is an elective cosmetic procedure, it won’t cover the cost. Medicare benefits exclude any cosmetic surgery unless there are special circumstances like you had an accident. The surgery will restore function to an area of your body that is contorted as a result of the accident. It also covers breast reconstruction surgery if you were a breast cancer patient who had a mastectomy. 

The transgender population took a special interest in this surgery. Both government insurance and private health insurance carriers have declined claims for facial feminization surgery. This is slowly starting to change. The United States prohibits discrimination based on gender identity in legislation. 

This surgery could significantly impact a person’s mental health and social welfare. The medical community is slowly showing signs that facial feminization surgery may be critical to some transgender people’s care. The Medicare Claims Processing Manual has a section on instructions for doctors on how they should code invoicing for gender identity disorders. 

Medicare benefits and facial feminization surgery cost

Medicare benefits now extend to routine preventative visits, regardless of gender markers. It also includes medically necessary hormone and transition-related therapy under the benefits. Medicare will determine whether or not the benefits extend to these treatments on a case-by-case basis, and the same goes for this type of surgery. 

If you are considering having facial feminization surgery, you could pay anywhere between $20,000 and $50,000 for the procedure. What you want done, your surgeon’s experience, and where you are will all factor into the cost. Facility costs, surgical services, medication, anesthesia fees, post-surgery needs, x-rays, and medical tests all factor into the cost. This is why it’s so important to check with your specific Medicare plan before you choose to have it. Medicare Advantage plans will also vary in their coverage amounts.

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