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Process & Fees


  1. Your first step would be to schedule a consultation to speak with Dr. Crane, Dr. Satterwhite, or Dr. Safir regarding your intended procedure.
  2. You will be emailed a surgery date approximately two to three weeks after your consultation which will include your pre and post-operative appointment dates.
  3. If using insurance, we will begin the authorization process within two to three months prior to your surgery date.
  4. We need all required support letters before we can initiate the authorization process (letter guidelines are below). We should receive these no later than one year prior to your surgery date.
  5. We will notify you if any issues arise and of the determination that we receive from your insurance company. You should also receive an authorization letter from your insurance company in the mail at the same time as our office.
  6. A comprehensive Surgery Confirmation Packet will be sent to you via email within 30 days prior to your surgery date, including detailed pre and post-operative care instructions.
  7. If you are paying out of pocket, your balance will be due no later than 30 days prior to your surgery date.


$300 Vaginoplasty, Phalloplasty, Metoidioplasty, and Revision (if initial surgery was performed by a provider outside of our practice) Consultation Fee (Out-of-Network Insurance and Self-Pay Patients Only)

$25 Physician Declaration Form Fee

$35 Notarized Physician Declaration Form Fee

$500 Surgery Deposit (Out-of-Network Insurance and Self-Pay Patients Only)

If you are paying out of pocket, a self-pay quote will be provided to you after your consultation.

If you are going through your insurance, you can expect to pay less than or up to your out-of-pocket maximum for your surgery.

In the event that we are unable to obtain an authorization prior to your surgery, you would have the option to pay out of pocket ahead of time or to reschedule your surgery date.

The surgeon’s fee will become due upfront prior to your surgery date if we are out-of-network with your insurance policy and we are unable to obtain an in-network exception and/or single case agreement for your surgery. We will then submit a claim to your insurance company and reimburse you what/if they pay minus your deductible and out-of-pocket maximum amounts.


Your insurance company will require letters from licensed mental health specialists and/or hormone prescribers.

Our office requires these letters at least one year prior to your surgical date in order to allow enough time to submit to your insurance company for prior authorization. We will review each letter and notify you if any revisions are necessary.

Please see the summary below for general requirements pertaining to each procedure. At the bottom of this page, you can find the general summary of information needed in a therapist letter.

Please note all letters must be signed by the provider and printed on letterhead. The letters cannot be written by an intern, even if they are co-signed.

The letters can be faxed, emailed, or mailed to our office.
FTM & Non-Conforming Top Surgery, Breast Augmentation, & Facial Feminization Surgery

(1) Letter from a qualified mental health professional (does not have to be a doctorate level)

FTM, MTF, & Non-Conforming Bottom Surgery

(1) Letter from a doctorate level mental health professional (highly recommended)

(1) Letter from a qualified mental health professional

(1) Letter from your hormone provider


The mental health letters must include:

1. Patient’s legal and preferred name

2. Patient’s date of birth

3. Date provider/patient relationship began and frequency of contact

4. Statement that patient has the capacity to make fully informed decisions and consent to treatment

5. Statement that patient has been diagnosed with Gender Identity Disorder/Gender Dysphoria and exhibits all of the following:

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

ii. The transsexual identity has been present persistently for at least two years; and

iii. The disorder is not a symptom of another mental disorder; and

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

6. The patient has undergone a minimum of 12 continuous months of hormone replacement therapy (bottom surgery only).

7. Documentation that the patient has completed a minimum of 12 months of successful continuous full-time real-life experience in their new gender, across a wide range of life experiences and events that may occur throughout the year.

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

The hormone provider letter can be much simpler. It should state:

1. Patient’s legal and preferred name

2. Patient’s date of birth

3. Date provider/patient relationship began and frequency of contact

4. Date hormone therapy began, frequency of treatment

5. That the patient has been undergone a minimum of 12 continuous months of hormone replacement therapy

6. That hormone therapy is specifically for the treatment of GID/Gender Dysphoria (If the patient has a contraindication to hormone therapy please have the provider note this).

*Please note that WPATH Standards of Care note that patients should be the age of majority (18 years of age in the US) for bottom surgery coverage, and it is very uncommon for minors to have this procedure approved.