{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:55:45Z","timestamp":1782968145399,"version":"3.54.5"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To provide a portrait of gender affirmation surgery (GAS) insurance coverage across the United States, with attention to procedures of the head and neck.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Systematic review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Policy review of US medical insurance companies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>State policies on transgender care for Medicaid insurance providers were collected for all 50 states. Each state\u2019s policy on GAS and facial gender affirmation surgery (FGAS) was examined. The largest medical insurance companies in the United States were identified using the National Association of Insurance Commissioners Market Share report. Policies of the top 49 primary commercial medical insurance companies were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Medicaid policy reviews found that 18 states offer some level of gender\u2010affirming coverage for their patients, but only 3\u00a0include FGAS (17%). Thirteen states prohibit Medicaid coverage of all transgender surgery, and 19 states have no published gender\u2010affirming medical care coverage policy. Ninety\u2010two percent of commercial medical insurance providers had a published policy on GAS coverage. Genital reconstruction was described as a medically necessary aspect of transgender care in 100% of the commercial policies reviewed. Ninety\u2010three percent discussed coverage of FGAS, but 51% considered these procedures cosmetic. Thyroid chondroplasty (20%) was the most commonly covered FGAS procedure. Mandibular and frontal bone contouring, rhinoplasty, blepharoplasty, and facial rhytidectomy were each covered by 13% of the medical policies reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While certain surgical aspects of gender\u2010affirming medical care are nearly ubiquitously covered by commercial insurance providers, FGAS is considered cosmetic by most Medicaid and commercial insurance providers, potentially limiting patient access.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level V.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599821997734","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T04:02:06Z","timestamp":1615867326000},"page":"791-797","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Insurance Coverage of Facial Gender Affirmation Surgery: A Review of Medicaid and Commercial Insurance"],"prefix":"10.1002","volume":"165","author":[{"given":"Enrique","family":"Gorbea","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Division of Facial Plastic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunder","family":"Gidumal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Division of Facial Plastic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aki","family":"Kozato","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Division of Facial Plastic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Henry","family":"Pang","sequence":"additional","affiliation":[{"name":"Center for Transgender Medicine and Surgery Mount Sinai Health System and Icahn School of Medicine at Mount Sinai New York New York USA"},{"name":"Department of Surgery Division of Plastic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Safer","sequence":"additional","affiliation":[{"name":"Center for Transgender Medicine and Surgery Mount Sinai Health System and Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Division of Facial Plastic Surgery Icahn School of Medicine at Mount Sinai New York New York USA"},{"name":"Center for Transgender Medicine and Surgery Mount Sinai Health System and Icahn School of Medicine at Mount Sinai New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,16]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Professional Association for Transgender Health. Publications. Accessed March 14 2020.https:\/\/www.wpath.org\/publications\/soc"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/15532739.2011.700873"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006837"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006012"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bodyim.2016.04.002"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/09540261.2015.1089217"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-015-0614-1"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000475754.71333.f6"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-010-9668-7"},{"key":"e_1_2_10_11_1","volume-title":"The Report of the 2015 U.S. Transgender Survey","author":"James SE","year":"2016"},{"key":"e_1_2_10_12_1","unstructured":"The Federal Register.Nondiscrimination in health programs and activities; a rule by the Health and Human Services Department on 05\/18\/2016. Accessed March 12 2020.https:\/\/www.federalregister.gov\/documents\/2016\/05\/18\/2016\u201011458\/nondiscrimination\u2010in\u2010health\u2010programs\u2010and\u2010activities?utm_campaign=subscription+mailing+list&utm_medium=email&utm_source=federalregister.gov"},{"key":"e_1_2_10_13_1","volume-title":"US Census Bureau"},{"key":"e_1_2_10_14_1","unstructured":"National Association of Insurance Commissioners.2018Market share reports for the top 125 accident and health insurance groups and companies by state and countrywide. Accessed March 12 2020.https:\/\/www.naic.org\/prod_serv\/MSR\u2010HB\u201019.pdf"},{"key":"e_1_2_10_15_1","article-title":"UCLA School of Law\u2010Williams Institute","author":"Mallory C","year":"2019","journal-title":"Medicaid Coverage for Gender Affirming Care"},{"key":"e_1_2_10_16_1","unstructured":"Husky HealthConn.Provider policies & procedures: gender affirmation surgery.2019. Accessed February 12 2020.https:\/\/www.huskyhealthct.org\/providers\/provider_postings\/policies_procedures\/Gender_Affirmation_Surgery.pdf"},{"key":"e_1_2_10_17_1","unstructured":"MassHealth.Guidelines for medical necessity determination for gender\u2010affirming surgery.2019. Accessed February 14 2020.https:\/\/www.mass.gov\/files\/documents\/2019\/08\/12\/mg\u2010genderaffirmingsurgery.pdf"},{"key":"e_1_2_10_18_1","unstructured":"Washington Administration Code \u00a7 182\u2010531\u20101675(2015)."},{"key":"e_1_2_10_19_1","unstructured":"Flack v. Wis. Dep\u2019t of Health Servs. 395 F. Supp. 3d 1001 (W.D. Wis.2019)."},{"key":"e_1_2_10_20_1","unstructured":"New York State Department of Health.New York State Medicaidupdate January 2017 Vol.33 Num. 1. Transgender related care and services update. Accessed February 14 2020.https:\/\/www.health.ny.gov\/health_care\/medicaid\/program\/update\/2017\/2017\u201001.html"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599821997734","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599821997734","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599821997734","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T14:18:05Z","timestamp":1760969885000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599821997734"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,16]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1177\/0194599821997734"],"URL":"https:\/\/doi.org\/10.1177\/0194599821997734","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,16]]},"assertion":[{"value":"2020-11-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}