Gender reassignment surgery. gender reassignment surgery 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, providing general information such as the member's name, administrative reference number, and date of birth. Ensure all fields are accurately filled to avoid delays.
3. Move to Section 2, where you will answer questions regarding the patient's treatment status and mental health conditions. This section is crucial for establishing the medical necessity of the surgery.
4. If applicable, complete Section 3 for female-to-male services or Section 4 for male-to-female services. Provide details on hormone therapy and referral letters from mental health professionals.
5. In Section 5, attach all required documentation including history and physical exams, office notes, and treatment descriptions. This ensures a comprehensive review of the request.
6. Finally, sign the form in Section 7. Remember that this form cannot initiate a precertification request; you must contact the Precertification Department directly or submit electronically.

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