FHIR IG analytics| Package | SHIFT-Task-Force.slsValueSets |
| Resource Type | ValueSet |
| Id | ValueSet-vs-gender-affirming-care-healthnet.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/SHIFT-Task-Force/SLS-ValueSets/ValueSet-vs-gender-affirming-care-healthnet.html |
| URL | http://SHIFT-Task-Force.github.io/slsValueSets/ValueSet/vs-gender-affirming-care-healthnet |
| Version | 0.0.1 |
| Status | active |
| Date | 2026-02-03T22:03:00+00:00 |
| Name | VS_Gender_Affirming_Care_HealthNet |
| Title | Gender-Affirming Care Codes (Health Net California) |
| Realm | uv |
| Description | CPT and ICD-10-CM codes referenced in Health Net California's clinical policy 'HNCA.CP.MP.496 - Gender Affirming Procedures'. Intended for segmentation of gender-affirming care under AB352. **Health Net Bulletin 24-351** Health Net's [bulletin 24-351](https://providerlibrary.healthnetcalifornia.com/) explicitly tells providers that services defined in policies like HNCA.CP.MP.496 must be: - **Blocked from automatic sharing** with the California Data Exchange Framework (DxF). - **Omitted from responses** to out-of-state subpoenas or investigations. - **Flagged within the EHR** to prevent unauthorized access by users outside of California. **Where to Find and Download HNCA.CP.MP.496.pdf** Health Net maintains this policy in several locations within their provider libraries: - **Direct PDF Link:** [HNCA.CP.MP.496 - Gender Affirming Procedures](https://providerlibrary.healthnetcalifornia.com/content/dam/centene/healthnet/pdfs/providerlibrary/HNCA.CP.MP.496.pdf) - **The Provider Library Archive:** You can find this by navigating to Health Net Provider Library > Resources > Clinical Policies and searching for `Gender Affirming Procedures` or the code `496.` |
No resources found
| CodeSystem | |
| cpt | Current Procedural Terminology (CPT®) |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet vs-gender-affirming-care-healthnet
FHIR
FHIRsmithhttp://www.ama-assn.org/go/cpt version Not Stated (use latest from terminology server)| Code | Display |
| 11960 | Insertion of tissue expander(s) for other than breast, including subsequent expansion |
| 11950 | Subcutaneous injection of filling material (eg, collagen); 1 cc or less |
| 11951 | Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc |
| 11952 | Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc |
| 11954 | Subcutaneous injection of filling material (eg, collagen); over 10.0 cc |
| 11970 | Replacement of tissue expander with permanent implant |
| 14000 | Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less |
| 14001 | Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm |
| 14040 | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less |
| 14041 | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm |
| 15100 | Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) |
| 15101 | Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) |
| 15120 | Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) |
| 15121 | Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) |
| 15200 | Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less |
| 15570 | Formation of direct or tubed pedicle, with or without transfer; trunk |
| 15574 | Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet |
| 15600 | Delay of flap or sectioning of flap (division and inset); at trunk |
| 15620 | Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet |
| 15757 | Free skin flap with microvascular anastomosis |
| 15758 | Free fascial flap with microvascular anastomosis |
| 15775 | Punch graft for hair transplant; 1 to 15 punch grafts |
| 15776 | Punch graft for hair transplant; more than 15 punch grafts |
| 15780 | Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) |
| 15781 | Dermabrasion; segmental, face |
| 15782 | Dermabrasion; regional, other than face |
| 15783 | Dermabrasion; superficial, any site (eg, tattoo removal) |
| 15786 | Abrasion; single lesion (eg, keratosis, scar) |
| 15787 | Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) |
| 15788 | Chemical peel, facial; epidermal |
| 15789 | Chemical peel, facial; dermal |
| 15792 | Chemical peel, nonfacial; epidermal |
| 15793 | Chemical peel, nonfacial; dermal |
| 15820 | Blepharoplasty, lower eyelid; |
| 15821 | Blepharoplasty, lower eyelid; with extensive herniated fat pad |
| 15822 | Blepharoplasty, upper eyelid; |
| 15823 | Blepharoplasty, upper eyelid; with excessive skin weighting down lid |
| 15824 | Rhytidectomy; forehead |
| 15825 | Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap) |
| 15826 | Rhytidectomy; glabellar frown lines |
| 15828 | Rhytidectomy; cheek, chin, and neck |
| 15829 | Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap |
| 15830 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy |
| 15832 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh |
| 15833 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg |
| 15834 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip |
| 15835 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock |
| 15836 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm |
| 15837 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand |
| 15838 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad |
| 15839 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area |
| 15876 | Suction assisted lipectomy; head and neck |
| 15877 | Suction assisted lipectomy; trunk |
| 15878 | Suction assisted lipectomy; upper extremity |
| 15879 | Suction assisted lipectomy; lower extremity |
| 17380 | Electrolysis epilation, each 30 minutes |
| 19300 | Mastectomy for gynecomastia |
| 19301 | Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); |
| 19303 | Mastectomy, simple, complete |
| 19316 | Mastopexy |
| 19318 | Breast reduction |
| 19325 | Breast augmentation with implant |
| 19350 | Nipple/areola reconstruction |
| 21120 | Genioplasty; augmentation (autograft, allograft, prosthetic material) |
| 21121 | Genioplasty; sliding osteotomy, single piece |
| 21122 | Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) |
| 21123 | Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) |
| 21125 | Augmentation, mandibular body or angle; prosthetic material |
| 21127 | Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) |
| 21208 | Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) |
| 21209 | Osteoplasty, facial bones; reduction |
| 21210 | Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) |
| 21270 | Malar augmentation, prosthetic material |
| 30400 | Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip |
| 30410 | Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip |
| 30420 | Rhinoplasty, primary; including major septal repair |
| 30430 | Rhinoplasty, secondary; minor revision (small amount of nasal tip work) |
| 30435 | Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) |
| 30450 | Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) |
| 31580 | Laryngoplasty; for laryngeal web, with indwelling keel or stent insertion |
| 31587 | Laryngoplasty, cricoid split, without graft placement |
| 31599 | Unlisted procedure, larynx |
| 31899 | Unlisted procedure, trachea, bronchi |
| 44145 | Colectomy, partial; with coloproctostomy (low pelvic anastomosis) |
| 53400 | Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type) |
| 53405 | Urethroplasty; second stage (formation of urethra), including urinary diversion |
| 53410 | Urethroplasty, 1-stage reconstruction of male anterior urethra |
| 53415 | Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra |
| 53420 | Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage |
| 53425 | Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage |
| 53430 | Urethroplasty, reconstruction of female urethra |
| 53460 | Urethromeatoplasty, with partial excision of distal urethral segment (Richardson type procedure) |
| 54125 | Amputation of penis; complete |
| 54340 | Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple |
| 54400 | Insertion of penile prosthesis; non-inflatable (semi-rigid) |
| 54401 | Insertion of penile prosthesis; inflatable (self-contained) |
| 54405 | Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir |
| 54406 | Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis |
| 54408 | Repair of component(s) of a multi-component, inflatable penile prosthesis |
| 54410 | Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session |
| 54411 | Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue |
| 54415 | Removal of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis, without replacement of prosthesis |
| 54416 | Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session |
| 54417 | Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue |
| 54520 | Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach |
| 54660 | Insertion of testicular prosthesis (separate procedure) |
| 54690 | Laparoscopy, surgical; orchiectomy |
| 55175 | Scrotoplasty; simple |
| 55180 | Scrotoplasty; complicated |
| 55970 | Intersex surgery; male to female |
| 55980 | Intersex surgery; female to male |
| 56625 | Vulvectomy simple; complete |
| 56800 | Plastic repair of introitus |
| 56805 | Clitoroplasty for intersex state |
| 56810 | Perineoplasty, repair of perineum, nonobstetrical (separate procedure) |
| 57106 | Vaginectomy, partial removal of vaginal wall; |
| 57107 | Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) |
| 57110 | Vaginectomy, complete removal of vaginal wall; |
| 57111 | Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) |
| 57291 | Construction of artificial vagina; without graft |
| 57292 | Construction of artificial vagina; with graft |
| 57295 | Revision (including removal) of prosthetic vaginal graft; vaginal approach |
| 57296 | Revision (including removal) of prosthetic vaginal graft; open abdominal approach |
| 57335 | Vaginoplasty for intersex state |
| 57426 | Revision (including removal) of prosthetic vaginal graft, laparoscopic approach |
| 58150 | Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); |
| 58180 | Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) |
| 58260 | Vaginal hysterectomy, for uterus 250 g or less; |
| 58262 | Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) |
| 58263 | Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele |
| 58267 | Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control |
| 58270 | Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele |
| 58275 | Vaginal hysterectomy, with total or partial vaginectomy; |
| 58280 | Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele |
| 58285 | Vaginal hysterectomy, radical (Schauta type operation) |
{
"resourceType": "ValueSet",
"id": "vs-gender-affirming-care-healthnet",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"url": "http://SHIFT-Task-Force.github.io/slsValueSets/ValueSet/vs-gender-affirming-care-healthnet",
"version": "0.0.1",
"name": "VS_Gender_Affirming_Care_HealthNet",
"title": "Gender-Affirming Care Codes (Health Net California)",
"status": "active",
"experimental": false,
"date": "2026-02-03T22:03:00+00:00",
"publisher": "SHIFT-Task-Force",
"contact": [
{
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"telecom": [
{
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"value": "http://shift-project.org"
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}
],
"description": "CPT and ICD-10-CM codes referenced in Health Net California's clinical policy\n'HNCA.CP.MP.496 - Gender Affirming Procedures'. Intended for segmentation of\ngender-affirming care under AB352.\n\n**Health Net Bulletin 24-351**\n\nHealth Net's [bulletin 24-351](https://providerlibrary.healthnetcalifornia.com/) explicitly tells providers that services defined in policies like HNCA.CP.MP.496 must be:\n\n- **Blocked from automatic sharing** with the California Data Exchange Framework (DxF).\n- **Omitted from responses** to out-of-state subpoenas or investigations.\n- **Flagged within the EHR** to prevent unauthorized access by users outside of California.\n\n**Where to Find and Download HNCA.CP.MP.496.pdf** Health Net maintains this policy in several locations within their provider libraries:\n\n- **Direct PDF Link:** [HNCA.CP.MP.496 - Gender Affirming Procedures](https://providerlibrary.healthnetcalifornia.com/content/dam/centene/healthnet/pdfs/providerlibrary/HNCA.CP.MP.496.pdf)\n- **The Provider Library Archive:** You can find this by navigating to Health Net Provider Library > Resources > Clinical Policies and searching for `Gender Affirming Procedures` or the code `496.`",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001"
}
]
}
],
"compose": {
"include": [
{
"system": "http://www.ama-assn.org/go/cpt",
"concept": [
{
"code": "11960"
},
{
"code": "11950"
},
{
"code": "11951"
},
{
"code": "11952"
},
{
"code": "11954"
},
{
"code": "11970"
},
{
"code": "14000"
},
{
"code": "14001"
},
{
"code": "14040"
},
{
"code": "14041"
},
{
"code": "15100"
},
{
"code": "15101"
},
{
"code": "15120"
},
{
"code": "15121"
},
{
"code": "15200"
},
{
"code": "15570"
},
{
"code": "15574"
},
{
"code": "15600"
},
{
"code": "15620"
},
{
"code": "15757"
},
{
"code": "15758"
},
{
"code": "15775"
},
{
"code": "15776"
},
{
"code": "15780"
},
{
"code": "15781"
},
{
"code": "15782"
},
{
"code": "15783"
},
{
"code": "15786"
},
{
"code": "15787"
},
{
"code": "15788"
},
{
"code": "15789"
},
{
"code": "15792"
},
{
"code": "15793"
},
{
"code": "15820"
},
{
"code": "15821"
},
{
"code": "15822"
},
{
"code": "15823"
},
{
"code": "15824"
},
{
"code": "15825"
},
{
"code": "15826"
},
{
"code": "15828"
},
{
"code": "15829"
},
{
"code": "15830"
},
{
"code": "15832"
},
{
"code": "15833"
},
{
"code": "15834"
},
{
"code": "15835"
},
{
"code": "15836"
},
{
"code": "15837"
},
{
"code": "15838"
},
{
"code": "15839"
},
{
"code": "15876"
},
{
"code": "15877"
},
{
"code": "15878"
},
{
"code": "15879"
},
{
"code": "17380"
},
{
"code": "19300"
},
{
"code": "19301"
},
{
"code": "19303"
},
{
"code": "19316"
},
{
"code": "19318"
},
{
"code": "19325"
},
{
"code": "19350"
},
{
"code": "21120"
},
{
"code": "21121"
},
{
"code": "21122"
},
{
"code": "21123"
},
{
"code": "21125"
},
{
"code": "21127"
},
{
"code": "21208"
},
{
"code": "21209"
},
{
"code": "21210"
},
{
"code": "21270"
},
{
"code": "30400"
},
{
"code": "30410"
},
{
"code": "30420"
},
{
"code": "30430"
},
{
"code": "30435"
},
{
"code": "30450"
},
{
"code": "31580"
},
{
"code": "31587"
},
{
"code": "31599"
},
{
"code": "31899"
},
{
"code": "44145"
},
{
"code": "53400"
},
{
"code": "53405"
},
{
"code": "53410"
},
{
"code": "53415"
},
{
"code": "53420"
},
{
"code": "53425"
},
{
"code": "53430"
},
{
"code": "53460"
},
{
"code": "54125"
},
{
"code": "54340"
},
{
"code": "54400"
},
{
"code": "54401"
},
{
"code": "54405"
},
{
"code": "54406"
},
{
"code": "54408"
},
{
"code": "54410"
},
{
"code": "54411"
},
{
"code": "54415"
},
{
"code": "54416"
},
{
"code": "54417"
},
{
"code": "54520"
},
{
"code": "54660"
},
{
"code": "54690"
},
{
"code": "55175"
},
{
"code": "55180"
},
{
"code": "55970"
},
{
"code": "55980"
},
{
"code": "56625"
},
{
"code": "56800"
},
{
"code": "56805"
},
{
"code": "56810"
},
{
"code": "57106"
},
{
"code": "57107"
},
{
"code": "57110"
},
{
"code": "57111"
},
{
"code": "57291"
},
{
"code": "57292"
},
{
"code": "57295"
},
{
"code": "57296"
},
{
"code": "57335"
},
{
"code": "57426"
},
{
"code": "58150"
},
{
"code": "58180"
},
{
"code": "58260"
},
{
"code": "58262"
},
{
"code": "58263"
},
{
"code": "58267"
},
{
"code": "58270"
},
{
"code": "58275"
},
{
"code": "58280"
},
{
"code": "58285"
}
]
}
]
}
}