Surgical Eligibility & Documentation Protocols

We are committed to evidence-based safety and strict adherence to medical standards. Genital reconstruction is a major surgical intervention with permanent, irreversible physical consequences. To ensure patient safety and compliance with insurance authorization mandates, our office enforces rigorous eligibility criteria.

We require a complete documentation packet to verify medical necessity and minimize the risk of coverage denial.

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FOR THE PATIENT: Eligibility Requirements

Before scheduling surgery, you must meet the following criteria to ensure medical readiness and insurance compliance:

• Established Care: You must be in an active therapeutic relationship (minimum 12 months) with a provider who can attest to your stability. Note: We do not accept letters from "assessment-only" online services.

• Holistic Screening: You must be screened and stabilized for any co-occurring conditions that could impact recovery or consent, including neurodivergence or complex trauma.

• Informed Consent: You must demonstrate a clear understanding that these procedures carry inherent risks and that long-term data (20+ years) regarding specific health outcomes is still evolving.

• Hormone Therapy: 12+ months of continuous hormone therapy (unless medically contraindicated).

• Social Transition: 12+ months of living in your affirmed gender identity.​

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Required Documentation:

To satisfy insurance authorization protocols, we require three (3) distinct letters of recommendation (all letters must be dated within 12 months of surgery):

1. Mental Health Professional 1: A psychiatrist or psychologist experienced in the treatment of gender dysphoria.

2. Mental Health Professional 2: A second licensed mental health provider.

3. Hormone Provider: The physician managing the patient's endocrine therapy.

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FOR THE LETTER WRITER: Documentation Standards​

Clinical Content Guidelines Letters must specifically address the following points to meet payer criteria for "Medical Necessity":

• Patient Identification: General identifying characteristics and confirmation of age of majority.

• Diagnostic History: Initial and evolving diagnoses, specifically regarding Gender Dysphoria and any psychiatric comorbidities.

• Treatment History: Duration of the professional relationship and the specific type of psychotherapy or evaluation conducted.

• Eligibility Verification: A clear statement that the patient meets standard criteria for surgery:

  • Persistent, well-documented Gender Dysphoria.

  • Capacity to make fully informed decisions and consent to treatment.

  • Well-controlled medical and mental health concerns.

  • 12 months of hormone therapy and congruent gender role experience.

• Post-Surgical Plan: The clinician's rationale for surgery and confirmation that the patient understands post-operative recovery and follow-up requirements.

 

Note on Insurance Compliance: Most carriers require current supporting letters for all masculinizing reconstruction procedures, regardless of prior surgical history. This includes penile/testicular implants, urethroplasty, or phallic/scrotal reconstruction.

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