Blue Cross and Blue Shield of Minnesota policy

Gender Affirming Procedures

Gender Affirming Procedures is a public Blue Cross and Blue Shield of Minnesota policy (policy IV-123, effective Apr 27, 2026). It lists 141 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

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Payer
Blue Cross and Blue Shield of Minnesota
Policy number
IV-123
Effective
Apr 27, 2026
Line of business
Commercial, Medicaid
Source
securecms.bluecrossmnonline.com

Codes in this policy

The CPT and HCPCS codes the policy names. A policy can name a code it excludes.

CodeOther Blue Cross and Blue Shield of Minnesota policies
01036Policies naming 01036
02976Policies naming 02976
08389Policies naming 08389
11950Policies naming 11950
11951Policies naming 11951
11952Policies naming 11952
11954Policies naming 11954
13815Policies naming 13815
13887Policies naming 13887
14000Policies naming 14000
14001Policies naming 14001
14041Policies naming 14041
14943Policies naming 14943
15734Policies naming 15734
15738Policies naming 15738
15750Policies naming 15750
15757Policies naming 15757
15758Policies naming 15758
15769Policies naming 15769
15771Policies naming 15771
15772Policies naming 15772
15773Policies naming 15773
15774Policies naming 15774
15820Policies naming 15820
15821Policies naming 15821
15822Policies naming 15822
15823Policies naming 15823
15824Policies naming 15824
15825Policies naming 15825
15826Policies naming 15826
15828Policies naming 15828
15829Policies naming 15829
15830Policies naming 15830
15832Policies naming 15832
15833Policies naming 15833
15834Policies naming 15834
15835Policies naming 15835
15836Policies naming 15836
15837Policies naming 15837
15838Policies naming 15838
15839Policies naming 15839
15847Policies naming 15847
15876Policies naming 15876
15877Policies naming 15877
15878Policies naming 15878
15879Policies naming 15879
17380Policies naming 17380
17999Policies naming 17999
19316Policies naming 19316
19318Policies naming 19318
19325Policies naming 19325
19340Policies naming 19340
19342Policies naming 19342
19350Policies naming 19350
21120Policies naming 21120
21121Policies naming 21121
21122Policies naming 21122
21123Policies naming 21123
21125Policies naming 21125
21127Policies naming 21127
21137Policies naming 21137
21138Policies naming 21138
21139Policies naming 21139
21172Policies naming 21172
21175Policies naming 21175
21179Policies naming 21179
21180Policies naming 21180
21208Policies naming 21208
21209Policies naming 21209
21210Policies naming 21210
21270Policies naming 21270
21899Policies naming 21899
30400Policies naming 30400
30410Policies naming 30410
30420Policies naming 30420
30430Policies naming 30430
30435Policies naming 30435
30450Policies naming 30450
31599Policies naming 31599
31899Policies naming 31899
40799Policies naming 40799
53410Policies naming 53410
53430Policies naming 53430
54125Policies naming 54125
54400Policies naming 54400
54401Policies naming 54401
54405Policies naming 54405
54406Policies naming 54406
54408Policies naming 54408
54410Policies naming 54410
54411Policies naming 54411
54415Policies naming 54415
54416Policies naming 54416
54417Policies naming 54417
54520Policies naming 54520
54660Policies naming 54660
54690Policies naming 54690
55175Policies naming 55175
55180Policies naming 55180
55970Policies naming 55970
55980Policies naming 55980
56620Policies naming 56620
56625Policies naming 56625
56800Policies naming 56800
56805Policies naming 56805
57110Policies naming 57110
57291Policies naming 57291
57292Policies naming 57292
57335Policies naming 57335
57472Policies naming 57472
58150Policies naming 58150
58180Policies naming 58180
58260Policies naming 58260
58262Policies naming 58262
58275Policies naming 58275
58290Policies naming 58290
58291Policies naming 58291
58541Policies naming 58541
58542Policies naming 58542
58543Policies naming 58543
58544Policies naming 58544
58550Policies naming 58550
58552Policies naming 58552
58553Policies naming 58553
58554Policies naming 58554
58570Policies naming 58570
58571Policies naming 58571
58572Policies naming 58572
58573Policies naming 58573
58661Policies naming 58661
58720Policies naming 58720
58940Policies naming 58940
64856Policies naming 64856
64892Policies naming 64892
64896Policies naming 64896
67900Policies naming 67900
92507Policies naming 92507
92508Policies naming 92508
92524Policies naming 92524
96158Policies naming 96158
96159Policies naming 96159

All Blue Cross and Blue Shield of Minnesota policies

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.