D135. Price Transparency for Gender-Affirming Surgical Procedures in Large U.S. Hospitals

PURPOSE: Cost concerns are prominent impediments to transgender and gender-diverse (TGD) people seeking gender-affirming surgery (GAS). This study examines GAS availability and price transparency efforts in large U.S. hospitals. METHODS: We examined 66 common gender-affirming procedures using the 100 largest US hospitals' price estimator tools. Information on states' bans on insurance exclusions for TGD-related care was gathered from the Movement Advancement Project. Statistical tests explored relationships between variables. RESULTS: Hospitals from 30 states were included, and 59 hospitals publicly offered GAS. Hospitals in states with transgender-protective laws were more likely to publicly offer GAS than those that were not (p<0.001). 48 hospitals disclosed prices for at least one of 66 procedures (median: two GAS prices). Chest surgeries were the most commonly reported prices (n=44). Partial mastectomy was the most common (n=33), followed by breast reduction (n=27), complete mastectomy (n=22), and breast augmentation (n=10). 15 hospitals provided genital surgery price information. Only one hospital published prices for vaginoplasty and no hospitals provided prices for a phalloplasty-bundle. Nine hospitals provided prices for gender-affirming facial and neck surgeries. Hospitals' location in states with insurance-exclusion bans, publicly offering GAS, and U.S. region showed no significant correlation with increased GAS price transparency. CONCLUSION: Nationwide, GAS price transparency is severely lacking, even in states with transgender-protective laws and hospitals that offer these surgeries. Establishing dedicated CPT codes could improve price transparency. Hospitals should enhance improve their online pricing information and implement CPT-bundling systems, empowering patients to anticipate costs before undergoing surgery.