Refer a patient for gender-affirming surgery and procedures

Facial and body hair removal does not require a referral to Gender Health SF. Please note that as of this writing, San Francisco Health Plan Medi-Cal (SFHP) is the only Medi-Cal plan that provides coverage for gender-affirming hair reduction.

For patients with San Francisco Health Plan Medi-Cal (SFHP):

PCP offices can directly refer patients for hair removal by following these steps.

1. PCP to document in a progress note that the patient has gender dysphoria associated with hair growth (specify body locations) and removal is a medically necessary treatment.
2. PCP office (ie, RN) to directly submit Prior Authorization to SFHP, using the following information
   • SFHP Pre-Authorization Form can be found here 
   • Consider registering to submit prior authorization via SFHP's online Portal, refer to their website for more information.

Codes for completing PA:

Diagnosis code: F64.1

Service codes:

- Code: 17999 QTY: 6 Description: Laser Hair Removal

- Code: 17380 QTY: 40 Description: Electrolysis

Authorized providers: 

Gender Confirmation Center

Specialty: Laser Hair Removal (currently limited to facial and surgical site hair removal)

NPI: 1669552212

Phone: 415-398-7784

Fax: 415-398-7784

450 Sutter St. Suite 1000

San Francisco, CA 94103

North Bay Aesthetics

Specialty: Laser Hair Removal (inclusive of all body areas)

NPI: 1861046195

Phone: 415-686-3546

Fax# 855-933-2612

233 Grant Avenue, Suite 600

San Francisco, CA 94108

Hearten Electrolysis

Specialty: Electrolysis

NPI: 1225783624

Phone: 415-470-0140

Fax: 415-287-6652

NOB HILL

1528 1/2 California Street

San Francisco, CA 94109

UNION SQUARE

500 Sutter Street Suite 908

San Francisco, CA 94102

Fringe Electrolysis

Specialty: Electrolysis

NPI: 1184188476

Phone:  (415) 913 - 9097

Fax: 415-358-9670

1731-B Buchanan St.

San Francisco, CA

Dimitra's Skin Care & Electrolysis

Specialty: Electrolysis

NPI: 1710390919

Phone: (415) 731-8080

Fax: 415-681-6661

324 West Portal Avenue

San Francisco, CA 94127

For patients with Healthy San Francisco (HSF):

Healthy SF covers surgical site hair reduction in preparation for genital surgery only, for which Gender Health SF manages a waitlist. Our office will send a direct referral to one of the available laser hair removal practices upon our receipt of referral for genital surgery, with consideration to the current waitlist. No additional action on the part of PCP office is needed.

For patients with Healthy SF

Refer to Gender Health SF using e-Consult. Mark the “other” option on the surgery referral template and specify patient with HSF seeking voice services. Gender Health SF will then add patient to Healthy SF waitlist and, once services available, will refer to UCSF Voice & Swallowing Center for a comprehensive multidisciplinary voice evaluation and neck contour assessment. Gender Health SF does not typically provide navigation services for Voice & Swallowing Center referrals.

For patients with San Francisco Health Plan (SFHP) Medi-Cal and other insurances

PCP's should refer directly to UCSF Voice & Swallowing Center for a comprehensive multidisciplinary voice evaluation and neck contour assessment using the steps below. Please note that GHSF does not have a role in processing these referrals. In addition, Gender Health SF does not typically provide navigation services for Voice & Swallowing Center referrals.

Please counsel patients that at their first visit with the Voice & Swallowing Center, they will meet with a Physician and a Speech Language Pathologist together. The purpose of this visit is for the team to learn what the patient's voice, communication and neck contour goals are, and to provide information on treatments available to them--these may include speech therapy, chondrolaryngoplasty (aka “tracheal shave”), and, in some cases, voice surgery.

Steps for PCP's to refer to UCSF Voice & Swallowing Center using Epic/CareLink

• Go to "Orders"
• Click on "Database" tab in upper right corner to expand options (you will not find it under "Preference List" tab)
• Type in "External Referral Speech"
• You will see one option appear: "External (non-DPH) Referral to speech therapy"
• In the comments section, free type your referral message: "Referring pt for gender affirming voice evaluation and treatment"  (You can save this referral with comments to your favorites to save time in the future.)

          UCSF Voice & Swallowing Center

          Phone: (415) 885-7700

          Fax: (415) 885-7800

          2330 Post Street, 5th Floor

          San Francisco, CA 94115

• Route referral/or message the appropriate staff member in your clinic to fax the referral and to follow up to ensure it was received. (Our Epic system unfortunately does not directly interface with UCSF specialty clinics and your external referral will not be automatically routed to anyone for action, so you must take this added step.)

• Please ask your team member faxing referral to include your most recent progress note; no additional documentation is required by the Voice and Swallowing Center.  Their office will submit a Prior Authorization to SFHP.

The Voice & Swallowing Center typically routes their visit notes to patients’ PCP; you can also view visits under Encounters on Epic and/or via CareEverywhere. It is recommended to review these to be aware of treatment plan, in particular any planned surgery.

Gender Health SF has a limited annual budget for participants in the Healthy SF program who are seeking gender-affirming surgeries. The approval for surgical consultations and surgeries depends on the program's budget. If there is a high demand, participants may be placed on a waitlist. Throughout the process, a patient's navigator will be available to discuss options and provide support.

Here are the steps to consider:

1. Take a look at the Gender Health Insurance and Health Benefits chart to find out which surgeries are covered under Healthy SF.
2. Primary care providers need to submit patient referrals to GHSF.
3. If the surgeries are available within the network, GHSF will refer the patients to ZSFG (Zuckerberg San Francisco General Hospital) or UCSF-tertiary care. 
4. If the surgeries are out-of-network, GHSF will handle the pre-authorization process for surgical consultations and referrals.