Gender Affirming Surgery Referral Letters (18+Adults only ) 60-minute meeting

$520

A support letter from a licensed mental health professional, such as myself –a psychotherapist or psychiatrist–may be necessary to be eligible for surgery. Likewise, most insurance companies require a letter from a mental health procedure to justify covering the costs of gender-affirming surgery. My rate is a reflection of my experience, education, and training that I bring to ensure you receive quality care. A 60 minute initial intake ($260) meeting will be necessary to evaluate and gather details needed for the letter, and then 60 minutes of administrative time to create the letter ($260). Please make sure to factor in about 1-3 weeks to receive your final letter as there may be unforeseen revisions needed. Generally, you can expect to receive your letter from me within a week from our meeting day.

You can also find other low-cost gender-competent providers who can write you a support letter through the Gender Affirmative Letter Access Project (GALAP), the list of WPATH members, or other online search engines like Psychology Today. Generally speaking, your provider should be a licensed clinical mental health professional (MD/DO, LCSW, LMFT, etc.) with at least a master’s-level education and a familiarity with the WPATH’s Standards of Care.

Please be aware that some insurance companies, plans, and surgeons have additional requirements outside the published SOC. I recommend that you verify the letter requirements with your specific insurance plan and the surgeon who will be providing services before scheduling a meeting with me to ensure the timely completion of your letter.

Additional questions to consider asking your insurance company:

1. What is my out of network deductible?

2. What percentage is reimbursed before and then after that deductible is hit?

3. What is the specific reimbursement/coverage for CPT code 90791 (Initial evaluation) & 90837 (Individual Therapy; if seeking future therapy with me)?

Current SOC v7 requirements

All letters must be:

Dated within one year of surgery

On a mental health agency’s letterhead

Indicate the type of procedure (top surgery, vaginoplasty, phalloplasty, etc.).

Signed by the provider with their license number

Please note that an intern or resident cannot write letters.

Top Surgery, Breast Augmentation & Facial Feminization Surgery:

One letter from a licensed mental health specialist (LCSW, MFT, LMFT, CSW, Ph.D., Psy.D., etc.)

Bottom Surgery:

Two Letters from two different licensed mental health specialists.

1 letter can be from a provider who has only had an evaluative

It is highly recommended that at least one of the letters be from a provider with a doctorate-level degree (Ph.D., Psy.D., etc.). Please keep in mind I possess an MA at this time.

Mental health provider letter(s) must include ALL of the following:

Patient’s legal and preferred name

Patient’s date of birth

Date provider/patient relationship began and the frequency of contact

A statement that the patient has been diagnosed with persistent, well-documented gender dysphoria/gender identity disorder and exhibits all of the following:

The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make their body as congruent as possible with the preferred sex through surgery and hormone treatment and

The transgender identity has been present persistently for at least two years, and

The disorder is not a symptom of another mental health disorder, and

The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Documentation that the patient has completed at least 12 continuous months of living in a gender role congruent with their gender identity across various life experiences and events that may occur throughout the year.

The patient has undergone a minimum of 12 continuous months of hormone therapy. (RECOMMENDED FOR BOTTOM SURGERY & BREAST AUGMENTATION ONLY).

A statement that the patient can make fully informed decisions and consent to treatment.

That the patient can comply with long-term follow-up requirements and post-operative expectations have been addressed.

If the patient has significant medical or mental health issues present, they must be reasonably well controlled.

Any substance use (marijuana, alcohol, etc.) is well-controlled for at least 6 months before the patient’s surgical date.

The provider must state their experience with treating patients diagnosed with gender dysphoria.

If you are already an established individual therapy client (attended at least 4 sessions) of Existnow Therapy, you can obtain your letter for no additional charge—please contact me directly for more details.

The letters are valid for one year from the original signed date, and any additional revisions can be made within that time period for no extra charge. If the letter is not used within that year and another one is needed, then another complete evaluation must be purchased.

Refunds are not provided for any completed letters.