Effective April 1st, 2019, MSP added a new fee code (61053) for bilateral breast construction for gender affirming surgery (male to female – MtF). They’ve also amended 61054, so that transgender patients now must meet the clinical criteria for FtM surgery.

Here are the details: 

New Fee Code 61053 (Bilateral Breast Construction)

  • 61053 is only applicable if you have prior approval for transgender services. Without approval, it isn’t eligible as a MSP benefit. Approval for surgery requires a medical assessment by qualified medical assessors who have recognized and demonstrable expertise in the treatment of gender dysphoria. It’s done through the PHSA.
  • Your patient has to meet the clinical criteria for MtF surgery which are:  
  1. Persistent, well-documented gender dysphoria  
  2. Capacity to make a fully informed decision and to consent for treatment  
  3. Age of majority 
  4. If significant medical or mental concerns are present, they must be reasonably well-controlled 
  5. Completed at least 18 months of feminizing hormone therapy (with the purpose to maximize breast growth in order to have better surgical results).  


61054 Amendment (
Bilateral Mastectomy)

  • 61054 includes bilateral subcutaneous mastectomy, nipple-areolar reconstruction and chest wall reconstruction.
  • (NEWLY AMENDED) In order to be MSP approved, transgender patients must  meet the clinical criteria for FtM surgery which includes:  
  1. Persistent, well-documented gender dysphoria  
  2. Capacity to make a fully informed decision and to consent for treatment  
  3. Age of majority 
  4. If significant medical or mental concerns are present, they must be reasonably well-controlled  
  5. Completed at least 18 months of hormone therapy  

Extra Notes: 

  • Not billable in addition to 07498 (mastectomy, subcutaneous), 06157 (nipple-areolar reconstruction), and 61330, 61331, or 61332 (local tissue shifts, multiple).  
  • Otherwise subject to General Preamble rules for multiple surgery


If you have any questions about these fee codes or other MSP codes contact out billing team and leave us a detailed message.

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