Refer a Patient: Gender Affirming Health Program

Contact Us

(415) 885-7770

(415) 353-3399

If your patient is younger than 18, please refer them to the Child and Adolescent Gender Care Center instead. For help referring international patients, contact International Services.

Here's how to refer an adult patient who lives in the United States. Note the different instructions for surgical and non-surgical services.

Please note that your patient can schedule an appointment with us before the referral process is complete. Ask your patient to call the clinic, and we'll get things started.

Step 1: Obtain insurance pre-authorization

For primary care, hormone therapy and other non-surgical services

Use the following visit codes: 99204, 99213 and 99214.

For surgical services

Use visit codes 99245 and 99244, and the following procedure CPT codes as appropriate:

Bilateral breast augmentation: 19325, 19325-50
Bilateral mastectomy and areola reconstruction (top surgery): 19303, 19403-50, 19350, 19350-50

Step 2: Write medical clearance letter (surgical services only)

If you're referring a patient for surgical services, please write a medical clearance letter. (Download a sample letter.)

Step 3: Submit the referral

You may refer online, by fax or through MD Link.

Refer online

Complete and submit this form, which auto-fills some fields after selecting the referring provider.

Refer by fax

Download our referral form as a PDF and complete it.

For primary care, hormone therapy and other non-surgical services:

Fax the completed referral form and insurance authorization to the number above, marked "Attn: Dr. Maddie Deutsch."

For surgical services:

Fax the completed referral form, insurance authorization, and medical clearance letter to the number above, marked "Attn: Gender Affirming Health Program navigator."