Facial feminization surgery (FFS) is undertaken to reconstruct masculine facial features to present a feminine form. The objective is to soften the facial aspects that are commonly considered masculine such as the nasal shape and bone structure. Soft tissue in the face or neck may also be altered.
Medicare Benefits for Surgery
Before you schedule any type of surgery, ask your doctor if it will be an inpatient or outpatient procedure. If it will be outpatient, you may have the option of choosing an ambulatory surgical center or the outpatient facility of a hospital. Medicare Part A (hospital insurance) covers inpatient care in a hospital, skilled nursing facility and religious non-medical health care institution. Hospice and home health care are also included in Medicare Part A.
Part B (medical insurance) includes physician services deemed medically necessary, outpatient care, home health services, durable medical equipment and mental health services. Medicare Part A and Part B are both subject to a deductible.
Coverage for Facial Feminization Surgery
If Medicare classifies a facial feminization procedure as an elective cosmetic surgery, it is unlikely to be covered. Cosmetic surgery is excluded from Medicare benefits except under special circumstances such as surgery required to restore function to a contorted area of the body injured from an accident. Additionally, breast reconstruction following the mastectomy of a breast cancer patient is covered.
There is particular interest in FFS among the transgender population as well as other gender identities. From an historical perspective, both private health insurance carriers and government insurance have declined claims for FFS. However, this is starting to change. The United States includes gender identity in legislation that prohibits discrimination.
As noted on Healthline, FFS may significantly affect someone’s mental health and social welfare even more than genital surgery. Though it is a slow evolution, the medical community is showing signs of recognition that FFS may be critical to the overall care of transgender people. The Medicare Claims Processing Manual, which is a resource for medical practitioners, includes instructions on invoice coding for gender identity disorders.
The National Center for Transgender Equality states that Medicare now covers routine preventive visits regardless of gender markers as well as medically necessary hormone and transition-related therapy. Just as Medicare determines benefits for most medical treatments on a case-by-case basis, the same rules apply to transition-related care.
Someone contemplating FFS should expect to pay anywhere between $20,000 and $50,000, which varies with the surgeon’s experience and geography as well as the constituent parts of the procedure. Costs include surgical services, facility costs, anesthesia fees, medication, post-surgery needs, medical tests and x-rays. Given this high expenditure, it is advisable to check with your specific Medicare plan to confirm coverage before deciding on your course of action.
Does Medicare Cover Eyelid Surgery?(Opens in a new browser tab)
Does Medicare Advantage Cover Prescription Drugs? (Opens in a new browser tab)