ICD Body System
Date amended:
External
Service Eligibility Assistant Document
Current RMA Instruments:
| Reasonable Hypothesis SOP | 113 of 2021 |
| Balance of Probabilities SOP | 114 of 2021 |
SOP bulletin information on new SOPs
ICD Coding
- ICD-10-AM Codes: F64.2, F64.9
Brief description
The SOP covers individuals whose gender identity or expression differs from their designated gender and where that difference is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Confirming the diagnosis
The RMA have defined this condition as a disorder of mental health, using DSM 5 criteria. Therefore a diagnosis from a psychiatirist consistent with the requirements of the Commission Guidelines for Psychiatric Claims is required.
Additional diagnoses/terms that may be covered by the SOP
- Non-binary gender identity
- Transgender
Conditions not covered by the SOP
- Gender dysphoria associated with inherited or congenital disorders of sex development (e.g. congenital adrenal hyperplasia and androgen insensitivity syndrome
- Less severe forms of gender incongruence that do not meet the criteria - not a disease.
Clinical onset
The SOP has no clinical onset factors. Onset is in childhood or adolescence.
Clinical worsening
Treatment may include mental health approaches, hormonal interventions and surgical interventions.