California Gender Recognition Act

Dear Colleagues,

Have you heard of the California Gender Recognition ACT (SB 179)? I would like to ask how folks are handling that throughout the Revenue Cycle Continuum from registration to claim drop. If a patient's identified gender is different than their anatomical gender how is that handled at your facility from registration to coding to billing to claim drop with the clearinghouses. The challenge with procedures etc that are specific to a gender if there is a mismatch the claim rejects. When there are clinical issues wherein a gender can cause the clinical practice and decisions to be different such as with troponin. Does your EMR have a place for this or is it Male, Female and Unknown or Other. Does anyone have policies, workflows etc?

I look forward to your thoughts.

Our IT sent this link.

California Gender Recognition Act (SB 179) | LGBT Resource Center (


  • We are just now starting this and working to get something going for our health system. We are well behind the times in South Carolina, but trying to get ahead of the game. We have no policies, but would also be interested to see what others have also.

  • Just wanted to add what CMS said about this in one of the 2023 rules

    In the MCE, the Sex conflict edit detects inconsistencies between a patient’s sex and any diagnosis or procedure on the patient’s record; for example, a male patient with cervical cancer (diagnosis) or a female patient with a prostatectomy (procedure). In both instances, the indicated diagnosis or the procedure conflicts with the stated sex of the patient. Therefore, the patient’s diagnosis, procedure, or sex is presumed to be incorrect.

    Comment: A commenter requested clarification on how the sex conflict edits consider patients who identify as transgender.

    The sex conflict edit under the MCE is consistent with 45 CFR §170.207(n) which states that birth sex must be coded as Male, Female or Unknown. Gender identity is a separate data element under 45 CFR §170.207(o).

    We intend to explore alternative options that may help to address the challenges described by the commenters with claims processing for individuals who identify as transgender or nonbinary.

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