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Billing for Transgender Services


To ensure that you do not receive denials for medical services that are considered gender specific, such as performing a hysterectomy on a male or diagnosing a female with testicular cancer, please submit claims with the appropriate information listed here.

In cases where the provider is aware the member identifies as one gender but has reproductive organs of the opposite gender, institutional providers should report condition code 45 (Ambiguous Gender Category) on both inpatient and outpatient services.

Professional claims should be billed with a KX modifier indicating the requirements specified in the medical policy have been met.