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a hospital, clinic, or lab. This policy informs them about when a service may be covered. 7.01.557_PBC (06-22-2022) Page | 2 of 40 ∞ Policy Coverage Criteria Refer to member contract language or call customer service to determine which gender transition/affirmation surgeries are covered by the Plan. This medical policy provides coverage criteria for those gender transition/affirmation surgeries that are covered by the Plan. Standard Benefit Coverage: Alaska Individual Plans and Employer Sponsored Group Plans These plans cover only mastectomy or breast reduction, augmentation mammoplasty, genital surgery, and hair removal related to genital surgery, including facility and anesthesia charges related to the surgery. Breast augmentation following the initial augmentation mammoplasty, hair removal not related to genital surgery, and other gender transition/affirmation surgeries are not covered. Expanded Benefit Coverage: Washington Fully-Insured, Individual Plans and Select Employer Sponsored Group Plans Some plans cover additional gender transition/affirmation surgeries for feminization, masculinization, or transition to non-binary, such as facial feminization or masculinization, body contouring, breast augmentation following the initial augmentation mammoplasty, voice surgery, and hair removal not related to genital surgery. Please refer to the member contract language or call customer service to determine whether the member’s plan provides expanded benefit coverage. Other plan customizations Some plans have customized benefits or criteria for coverage. Please refer to the member contract language or call customer service to determine whether the member’s plan has customized benefit coverage or criteria. Some member contracts may use alternate terms for gender transition/affirmation, such as gender confirmation, gender change, gender reassignment, or transgender. Patient reported outcomes in genital gender‑afrming surgery: the time is now Nnenaya Agochukwu‑Mmonu1,2* , Asa Radix3,4, Lee Zhao2 , Danil Makarov1,2, Rachel Bluebond‑Langner5 , A. Mark Fendrick6,7, Elijah Castle1,2 and Carolyn Berry2,3 Abstract Transgender and non-binary (TGNB) individuals often experience gender dysphoria. TGNB individuals with gender dysphoria may undergo genital gender-afrming surgery including vaginoplasty, phalloplasty, or metoidioplasty so that their genitourinary anatomy is congruent with their experienced gender. Given decreasing social stigma and increasing coverage from private and public payers, there has been a rapid increase in genital gender-afrming sur‑ gery in the past few years. As the incidence of genital gender-afrming surgery increases, a concurrent increase in the development and utilization of patient reported outcome measurement tools is critical. To date, there is no systematic way to assess and measure patients’ perspectives on their surgeries nor is there a validated measure to capture patient reported outcomes for TGNB individuals undergoing genital gender-afrming surgery. Without a systematic way to assess and measure patients’ perspectives on their care, there may be fragmentation of care. This fragmentation may result in challenges to ensure patients’ goals are at the forefront of shared- decision making. As we aim to increase access to surgical care for TGNB individuals, it is important to ensure this care is patient-centered and high-quality. The development of patient-reported outcomes for patients undergoing genital gender-afrming surgery is the frst step in ensuring high quality patient-centered care. Herein, we discuss the critical need for development of validated patient reported outcome measures for transgender and non-binary patients undergoing genital reconstruction. We also propose a model of patient-engaged patient reported outcome measure development. Keywords: Patient reported outcomes, PROs, Gender-afrming surgery, Vaginoplasty, Metoidioplasty, Phalloplasty © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Background Approximately 1 in every 200 US adults, roughly 1.4 million Americans, identify as transgender [1]. Some transgender and non-binary (TGNB) individuals experience gender dysphoria, which is discomfort, distress, physical, and psychological impairment that results from an incongruence between an individual’s gender identity and their sex assigned at birth [2]. TGNB individuals who experience gender dysphoria may seek medical and/or surgical interventions so that their physical features are
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