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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 4
Section 16.1
Intersex Surgery
Issue Date:  August 26, 1985
Authority:  32 CFR 199.4(e)(8)(ii)(D) and (g)(29)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-1, March 10, 2017
1.0  CPT PROCEDURE CODE RANGE
55970 - 55980
2.0  DESCRIPTION
Intersex involves an individual who shows intermingling, in varying degrees, of the characteristics of each sex, including physical form, reproductive organs, and sexual behavior.
3.0  POLICY
Surgery performed to correct ambiguous genitalia which has been documented to be present at birth is a covered benefit.
4.0  EXCLUSION
All services and supplies directly and indirectly related to surgical treatment (i.e., sex gender change), except when performed to correct ambiguous genitalia which is documented to have been present at birth (CPT procedure codes 55970 and 55980).
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