Expanded coverage for gender-affirming treatment

Effective January 1, 2024, Wellpoint will cover medically necessary gender–affirming treatment and services in a nondiscriminatory manner according to nondiscriminatory criteria that are consistent with current clinical standards. Prior authorization is required for certain medications, surgical procedures, and medical therapies. Please include modifier KX as appropriate. This modifier is used to alert that the physician/practitioner is performing a service on a patient for whom gender specific editing may apply but should have the editing bypassed.

You can find more information on the Maryland Department of Health’s website and in the notice titled Gender Affirming Treatment Services Under the Maryland Medicaid Program.

Required prior authorization services can be found on the Home | Wellpoint under Resources > Prior Authorization Lookup Tool.