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Clinical policy bulletins state deviations

Clinical policy bulletins (CPBs) may have deviations that outline how we cover and reimburse certain medical services in certain states.  This helps ensure our policies meet state regulations.

Find your state specific-information

Go to your state to find important coverage details.

 
  • For members of plans governed by the State of California: Medically necessary speech therapy services are covered whether or not a member's speech impediment and/or developmental disability has a physical cause.

     

    CPB 0243: Speech therapy
     

    For members of HMO/HNO plans regulated by the State of California Department of Managed Health Care: All cosmetic procedures that are performed as part of a gender transition must be reviewed for medical necessity.

     

    CPB 0615: Gender-affirming surgery

  • Pursuant to New York Department of Financial Services Insurance Circular Letter #3 issued February 23, 2021: Members covered under New York student health plans and fully-insured plans who are unable to conceive due to their sexual orientation or gender identity, and who also have coverage subject to the infertility mandates located at NY Insurance Law §§ 3221(k)(6)and 4303(s), are entitled to immediate coverage of certain infertility diagnostic and treatment services, including intrauterine insemination procedures, if the member’s plan covers the requested benefit.

  • For members of plans governed by the State of Oregon: All requests for services on the National Precertification List (NPL), when performed as part of gender-affirming treatment, will be approved for coverage without medical necessity review, both inpatient and outpatient. This includes, but isn’t limited to:

     

    • Electrolysis/laser hair removal
    • Tracheal shaves
    • Voice modification surgery (laryngoplasty)
    • Facial bone reduction or augmentation
    • Rhinoplasty
    • Forehead lift/lower hairline
    • Scalp hair transplantation
    • Rhytidectomy (face lift, facial liposuction, neck tightening)
    • Lip enhancement or reduction
    • Body contouring gender-affirming surgery, including liposuction/lipofilling/implants (pectoral, hip, gluteal, calf) (not an inclusive list)
    • Blepharoplasty
    • Brow lift
    • Cheek implants
    • Chin implants
    • Revisions to past gender-affirming treatment
    • Any combination of gender-affirming treatment procedures
  • For members of plans regulated by the Washington State Department of Insurance: These procedures that are performed as part of a gender transition must be reviewed for medical necessity:

     

    • Electrolysis/laser hair removal
    • Tracheal shaves
    • Voice modification surgery (laryngoplasty)
    • Facial bone reduction or augmentation
    • Rhinoplasty
    • Forehead lift/lower hairline
    • Scalp hair transplantation
    • Rhytidectomy (face lift, facial liposuction, neck tightening)
    • Lip enhancement or reduction
    • Blepharoplasty
    • Brow lift
    • Cheek implants
    • Chin implants

     

    All other gender-affirming surgery procedures, other than this list, are considered not medically necessary and cosmetic.

     

    For members of plans regulated by the Washington State Department of Insurance: To determine the medical necessity for the listed gender-affirming surgery procedures, this medical necessity criteria will be applied:

     

    • Signed letter from a qualified mental health professional to assess the transgender/gender diverse person’s readiness for physical treatments; and
    • Documentation of marked and sustained gender dysphoria; and
    • Exclusion of other possible causes of apparent gender incongruence; and
    • Assessment of mental and physical health conditions that could negatively impact the outcome of gender-affirming medical treatments, with discussion of risks and benefits; and
    • Capacity to consent for the specific physical treatment; and
    • Six months of continuous hormone therapy appropriate to the member's gender goals (12 months for adolescents less than 18 years of age), unless hormone therapy isn’t desired or medically contraindicated; and
    • Photographs to show features that are not compatible with the member's gender identity

     

    If these criteria aren’t met, the listed gender-affirming procedures are considered not medically necessary.

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