Aetna Gender Affirmation Surgery prior authorization requirements (2026)
What Aetna generally requires to approve Gender Affirmation Surgery (CPT 55970, 55980, 56805, 57335, 11950, 11951, 11952, 11954, 15771, 15772, 15775, 15776, 15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 15824, 15825, 15826, 15828, 17380, 19318, 21270, 30400, 30410, 30420, 30430, 30435, 30450, 53430, 54125, 54400, 54401, 54405, 54406, 54408, 54410, 54411, 54415, 54416, 54417, 54520, 54660, 54690, 55175, 55180, 56625, 56800, 56810, 57106, 57107, 57110, 57111, 57291, 57292, 58150, 58180, 58260, 58262, 58275, 58280, 58285, 58290, 58291, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58661, 58720), for Commercial plans. Yes. Aetna generally requires prior authorization for Gender Affirmation Surgery (CPT 55970, 55980, 56805, 57335, 11950, 11951, 11952, 11954, 15771, 15772, 15775, 15776, 15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 15824, 15825, 15826, 15828, 17380, 19318, 21270, 30400, 30410, 30420, 30430, 30435, 30450, 53430, 54125, 54400, 54401, 54405, 54406, 54408, 54410, 54411, 54415, 54416, 54417, 54520, 54660, 54690, 55175, 55180, 56625, 56800, 56810, 57106, 57107, 57110, 57111, 57291, 57292, 58150, 58180, 58260, 58262, 58275, 58280, 58285, 58290, 58291, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58661, 58720).
Medical-necessity criteria Aetna generally applies
Medical necessity review required
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Gender Affirmation Surgery. Confirm the covered diagnosis list against the current Aetna policy.
Commonly required documentation
- Complete medical records including mental health evaluation documentation
How to submit
- Method: portal
- Typical turnaround: about 3 days
Source
Standard precertification process applies Last verified 2026-05-06.
Frequently asked questions
Does Aetna require prior authorization for Gender Affirmation Surgery?
Yes. Aetna generally requires prior authorization for Gender Affirmation Surgery (CPT 55970, 55980, 56805, 57335, 11950, 11951, 11952, 11954, 15771, 15772, 15775, 15776, 15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 15824, 15825, 15826, 15828, 17380, 19318, 21270, 30400, 30410, 30420, 30430, 30435, 30450, 53430, 54125, 54400, 54401, 54405, 54406, 54408, 54410, 54411, 54415, 54416, 54417, 54520, 54660, 54690, 55175, 55180, 56625, 56800, 56810, 57106, 57107, 57110, 57111, 57291, 57292, 58150, 58180, 58260, 58262, 58275, 58280, 58285, 58290, 58291, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58661, 58720).
What does Aetna require to approve Gender Affirmation Surgery?
Medical necessity review required Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Aetna typically decides Gender Affirmation Surgery requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Gender Affirmation Surgery to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.