Kalavacherla Sandhya, Camacho Justin M, Cordero Justin, Kalavacherla Sruthi, Sheahan Lucy, Gosman Amanda
Department of Otolaryngology, Head and Neck Surgery, University of California San Diego School of Medicine, San Diego, USA.
Department of Medicine, Drexel University College of Medicine, Philadelphia, USA.
Cureus. 2025 Apr 23;17(4):e82849. doi: 10.7759/cureus.82849. eCollection 2025 Apr.
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.
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.
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%).
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.
面部女性化手术（FFS）可缓解性别焦虑症，但保险覆盖范围极小且报道不足。本研究使用全国性数据库分析门诊FFS治疗的总费用和主要支付方分布情况。
分析2017 - 2018年全国门诊手术样本数据，使用国际疾病分类第十版（ICD - 10）和现行程序编码（CPT）识别接受FFS的 transgender 患者。按手术程序和主要支付方类型对人口统计学、手术中心位置和总费用进行分层，并使用描述性统计进行比较。
共识别出3359次就诊，患者年龄中位数为42岁，费用中位数（四分位间距）为24,679美元（15,716美元，39,442美元）。私人保险是最常见的支付方（N = 1657，50%），其次是自费者（N = 667，20%）、医疗保险（N = 540，16%）和医疗补助（N = 286，8.3%）。自费者的费用中位数最高（27,736美元（17,392美元，39,385美元）），其次是私人保险（26,989美元（17,798美元，44,933美元））和医疗补助（26,968美元（16,756美元，46,467美元））。医疗保险的费用中位数最低（17,467美元（10,322美元，29,210美元））。费用因收入（p < 0.001）和位置（p < 0.001）存在显著差异，收入较高者和中心都市地区的费用最高（分别为25,249美元和26,782美元）。隆鼻术（N = 1990，59%）和提眉术（N = 363，11%）是最常见的手术。提眉术的费用中位数最低（11,834美元（8,366美元，18,317美元）），且最常由医疗保险支付（N = 217，60%）。以私人保险作为主要支付方时，隆鼻术的总费用为23,050美元（N = 1017，51%）。
本研究首次描述了门诊FFS的总费用和支付方分布情况。这一广泛分析凸显了FFS的巨大经济负担，尤其是对自费患者而言。
