Process and Fees

Notice to patients about open payments database

A link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments website is linked here. According to the federal Physician Payments Sunshine Act, payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals are to be made available to the public.


The process for beginning your surgical journey is simple and accommodating.

  • Step One

    Schedule a one-on-one virtual consultation with Dr. Angela Rodriguez.

  • Step Two

    Obtain and compile letters of support that are dated within one year of the planned procedure(s) for your transition from mental health professionals and hormone prescribers you work with. For any medical conditions, you may need to obtain letters of medical clearance, labs and specific studies.

  • Step Three

    Schedule your procedure(s).

  • Step Four

    Our team will initiate the insurance authorization process at least two to three months prior to your procedure date.

  • Step Five

    You will receive your detailed surgical packet, which will include pre-operative and post-operative instructions, in the mail 30-60 days prior to your surgery.

  • Step Six

    If you are paying out of pocket, pay the balance for your procedures.

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Letter Requirements:

If you need a prior-authorization for your surgery, you must obtain letters of support. The required letters depend on the procedure:

  • Breast augmentation, facial feminization and top surgery require one mental health letter from a licensed mental health provider
  • Vaginoplasty, phalloplasty and other bottom surgeries require two mental health letters from two different licensed mental health providers, as well as one from your hormone provider

Letters are reviewed based upon the patient’s insurance. If clarification is needed in the letters, we’ll notify the patients and recommend patients reach out to their providers for modifications.

Below is a list of letter requirements for your reference:

  • Patient’s legal and preferred name.
  • Patient’s date of birth.
  • Date provider/patient relationship began and frequency of contact.
  • Statement the patient has been diagnosed with persistent, documented gender dysphoria and exhibits all of the following:
    • The desire to live and be accepted as a member of the opposite sex, as well as the wish to make his or her body as harmonious as possible with the preferred sex through surgery and hormone treatment.
    • The transgender identity has been present persistently for at least two years.
    • The disorder is not a symptom of another mental health disorder.
    • The disorder causes the patient to experience clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • Documentation the patient has completed a minimum of 12 continuous months living within their identity through a range of life experiences and events throughout the year.
  • The patient has undergone a minimum of 12 continuous months of hormone replacement therapy*.
  • The patient is able to comply with long-term follow-up requirements and post-operative expectations have been addressed.
  • Any substance usage will be well controlled for at least six months prior to the patient’s procedure date.
  • Statement the patient is able to make fully informed decisions and to consent to treatment.
  • If the patient has significant medical or mental health issues, they must be well managed.
  • The provider writing the letter must state their experience with treating patients diagnosed with gender dysphoria.

*If you are currently not on hormones due to any contraindication or do not take hormones, please have your therapist or primary care physician note this in a letter.

The Hormone Provider Letter Must Include:

  • Patient’s legal and preferred name.
  • Patient’s date of birth.
  • Date provider/patient relationship began and frequency of contact.
  • Date hormone therapy began and frequency of treatment.
  • Confirmation the patient has completed a minimum of 12 continuous months of hormone therapy.

Have questions regarding the Process and Fees? Please reach out to the team at ART Surgical.