On May 28, 2025, CMS requested comments from hospitals to determine the quality of care being provided for gender dysphoria in children. CMS cites its prior communication and a prior report released by HHS as the basis for the inquiry and concern around the evidence supporting such care.
CMS has specifically requested that hospitals provide their policies and procedures with respect to the following:
- The adequacy of informed consent protocols for children with gender dysphoria, including how children are deemed capable of making these potentially life-changing decisions and when parental consent is required;
- Changes to clinical practice guidelines and protocols that the institution plans to enact in light of the recent comprehensive review of guidance released by HHS; and
- Any adverse events related to these procedures, particularly children who later look to detransition.
CMS is also reviewing the federal payment policies related to gender transition procedures for patients under the age of 19. To assist with this analysis, CMS is requesting that hospitals provide complete financial data for all pediatric sex trait modifications performed and paid for in whole, or in part by the federal government. This data includes:
- All billing codes utilized for pediatric sex trait modifications (and that correspond with pediatric sex trait modification procedures not determined to be medically necessary);
- Facility- and Provider-level revenue – or utilization data – generated, directly or indirectly, from these procedures (2020-present);
- Facility- and Provider-level operating and profit margins for each procedure type (for the institution as well as directly or indirectly owned and / or affiliated providers); and
- Projected revenue forecasts for these service lines.
Comments are due by June 27, 2025. A copy of CMS’s letter is available here.
