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Description:Because hormone therapy and gender reassignment surgery lead to irreversible changes, informed consent is typically required. All policies with an effective date in require documentation of gender dysphoria and refer to DSM-5 definitions. The table in Figure 2 provides the data fields as well as the data element options that can be included in billing, claims, and EHR systems. Most policies require letters from two qualified mental health professionals, though some require a letter from just one for limited gender reassignment surgery—for example, for an FTM patient seeking mastectomy only.