A National Ambulatory Surgery Sample Cost Analysis of Outpatient Facial Feminization Surgery.

INTRODUCTION

Facial feminization surgery (FFS) alleviates gender dysphoria, but insurance coverage is minimal and underreported. This study analyzes total charges and primary payer distributions for outpatient FFS care using a national database.

MATERIALS AND METHODS

Data from the 2017-2018 National Ambulatory Surgery Sample were analyzed to identify transgender patients undergoing FFS using ICD-10 and CPT codes. Demographics, surgery center location, and total charges were stratified by procedure and primary payer type and compared using descriptive statistics.

RESULTS

A total of 3,359 encounters were identified with a median patient age of 42 years and a median (interquartile range) charge of $24,679 ($15,716, $39,442). Private insurance was the most common payer (N=1657, 50%), followed by self-payers (N=667, 20%), Medicare (N=540, 16%), and Medicaid (N=286, 8.3%). Median costs were highest for self-payers ($27,736 ($17,392, $39,385)), followed by private insurance ($26,989 ($17,798, $44,933)) and Medicaid ($26,968 ($16,756, $46,467)). Medicare had the lowest median charge ($17,467 ($10,322, $29,210)). Charges differed significantly by income (p<0.001) and location (p<0.001), with higher earners and central metropolitan areas incurring the highest costs ($25,249 and $26,782, respectively). Rhinoplasty (N=1990, 59%) and brow lifts (N=363, 11%) were the most common procedures. Brow lifts had the lowest median cost ($11,834 ($8,366, $18,317)) and were most often covered by Medicare (N=217, 60%). The total charges for rhinoplasty were $23,050, with private insurance as the primary payer (N=1017, 51%).

CONCLUSIONS

This study is the first to characterize total charges and payer distributions for outpatient FFS. This broad analysis highlights the significant financial burden of FFS, especially on self-paying patients.