Facial Feminization Surgery FFS Insurance Coverage
Yes, we are one the few FFS centers that will accept health insurance if your health insurer provides coverage for FFS and willing to sign a letter of agreement to work with our center. We will work with your insurance to determine coverage which sometimes can cover as much as 100% of the cost. FFS insurance coverage is NOT common and often many insurers will place an exclusion from their health plans. Our practice is considered out-of-network with all insurance providers.
Facial Feminization Surgery Insurance Coverage
We have had success obtaining insurance coverage for Facial Feminization Surgery from health plans of large technology companies such as Apple, AT&T, Amazon, T-mobile, Dell, Boeing, Oracle, Google, Microsoft, Starbucks along with select health insurance plans from Massachusetts. Most other insurance plans do not cover FFS and consider it as cosmetic surgery. These are usually self-insured employer health plans. Insurances are constantly changing and we cannot make any guarantees concerning insurance coverage or approval.
Why should Facial Feminization Surgery be a covered benefit for a transgender patient?
We feel privileged that the #transgender community entrusts us with their gender transition and facial gender confirmation surgery. We feel FFS facial feminization surgery is reconstructive surgery and not cosmetic surgery to align one’s outer appearance to one’s identified gender.
Facial Feminization Surgery is a critical part of a transition timetable for a transgender patient who has decided to live full time as female. Most patients first begin working with a therapist before and after starting hormones. After being on hormones for an extended period of time, patients will make the transition to go “full time” and it can be essential to undergo FFS to increase acceptance of their new gender. The importance of “passing” and the role of facial features play an important part of how the general public and others perceive transgender patients. The therapeutic goal of transgender surgeries is to allow a transgender individual to successfully function socially as a member of their desired gender.
One of the most important components of the gender identification is the face and why we feel Facial Feminization Surgery should be considered a medically necessary procedure. Although it is clearly possible to transition from male to female without facial feminization surgery it can be extremely difficult for many individuals if their facial features are distinctly masculine. Even individuals that develop extremely feminine bodies as a result of hormones often find it extremely difficult to gain acceptance if their facial features are extremely masculine. The degree of acceptance individuals attain is often directly correlated with how “congruent” their gender.
Facial Feminization Surgery can affect the quality of day-to-day life far more than any other therapeutic procedure for a transgendered individual, often more so than Genital reassignment surgery. Facial features that are distinctly masculine can cause individuals to appear always “male” without surgery. Facial feminization surgery may have a far more profound effect on the quality of life of a transgender individual than genital reassignment surgery and why most patients elect to undergo FFS first and genital reassignment surgery after.
Guide to get your Facial Feminization Surgery surgery covered by insurance
Will insurance cover my surgery? And if it does, how much will I have to pay?
Below are some guidelines to help answer these questions. First step is to reach out to us for a consultation.
We have an Insurance Concierge who can work with your insurance and will help you through the insurance approval process until approval is achieved, or until the point where it is clear that you do not have coverage.
To help us , we need the following information from you:
Full Name
Date of Birth
Procedures you are looking to have covered
A scanned copy of your insurance card (front and back)
If available, Facesheet stating which FFS procedures are covered
Scenario 1: Your insurance carrier does not cover the cost of Facial Feminization Surgery.
What You Can Do:
Pay out-of-pocket for the procedure.
Finance your procedure with CareCredit.
Finance your procedure with a loan. There are several lenders who offer loans specifically for plastic surgery procedures.
Scenario 2: Your health insurance covers Facial Feminization Surgery.
What we will need from you for authorization approval:
a letter from a mental health provider stating that you meet WPATH guidelines for surgery
notes from your consultation with Dr. Keojampa which we will have ready 1-2 weeks after your consultation
There may be additional requirements based on individual circumstances such as a letter of agreement between our center and your health insurance company.
The process of obtaining all the necessary approvals for insurance coverage for facial feminization surgery can take several months depending on your insurer.
Gender Confirmation Surgery with Related Services – Examples from AT&T Benefits Insurance
Effective January 1, 2017 or as soon as administratively feasible thereafter, benefits provided under the AT&T self-insured medical
programs (currently administered by BCBS or UHC, depending on your program) will include coverage for gender confirmation
services based on the recommendations for medical standards of care issued by the World Professional Association for Transgender
Health (WPATH). The services currently included under this coverage are listed below.
Note: Members who meet the criteria for gender confirmation services may elect to have some or all appropriate services listed.
For example, an individual may choose to just have breast modification, but not the full male to female / female to male surgeries.
Facial Feminization Surgery Coverage
Covered Services
Primary Sexual Characteristic Services
Female to Male Surgeries
Male to Female Surgeries1
Secondary Sexual Characteristic Services
Reduction thyroid chondroplasty or trachea shaving (reduction of Adam’s apple)
Blepharoplasty (rejuvenation of the eyelid)
Brow lift
Calf implants
Cheek implants
Chin or nose implants
External penile prosthesis (vacuum erection devices)
Face lift (rhytidectomy)
Facial bone reconstruction/sculpturing/reduction, includes jaw shortening
Forehead lift or contouring
Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty)
Laryngoplasty
Lip reduction or lip enhancement
Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction
Neck tightening
Pectoral implants
Redundant/excessive skin removal
Rhinoplasty (nose correction)
Skin resurfacing
Voice modification surgery
Voice (speech) therapy or voice lessons
Treatment with hormone therapy or secondary sexual characteristic surgeries for individuals under
the age of majority (18 years old) i.e. puberty-suppressing hormones or masculinizing /feminizing
hormones
Abdominoplasty
Testicular expanders
Commonly used Insurance CPT codes for Facial Feminization Surgery
21139 Reduction Forehead; Contouring & Setback, Anterior Frontal Sinus Wall
67900 Repair, Brow Ptosis, (Supraciliary/Mid-Forehead/Coronal Approach)
61782 Stereotactic computer-assisted (navigational) procedure; cranial, extradural
14041 Scalp advancement
15776 Hair Transplants; > 15 Punch Grafts
15876 Suction Assisted Lipectomy; Head & Neck
20926 Tissue grafts, other (eg, paratenon, fat, dermis)
21122 Genioplasty; Sliding Osteotomies, 2+ Osteotomies
21195 Reconstruction, Mandibular Rami &/or Body, Sagittal Split; w/o Int Rigid Fixation
21209 Osteoplasty, Facial Bones; Reduction
21270 Malar Augmentation, Prosthetic Matl
Modifiers: -50 Bilateral Procedure
31599 Tracheal Shave
40652 Lip Lift
30410 Rhinoplasty; Primary; Complete
30520 Septoplasty
30140 Turbinate Resection w/ Submucosal Approach
Modifiers: -50 Bilateral Procedure