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Surgery letters: surgeon-specific, procedure-specific, and they expire

Letters supporting surgery are usually written for a specific surgeon and a specific procedure, and they do not transfer. Many plans also treat them as expiring, commonly after about eighteen months. Check both before you assume the letter you already have will work for the surgery you are actually scheduling.

Applies to All plan types. Requirements vary by plan, by surgeon, and by state; Colorado Medicaid requires only one letter for surgery.

What to do

  1. Ask the surgeon what they require, in writing

    Surgeon requirements and plan requirements are two different lists and they do not always match. Get both before commissioning anything.

  2. Ask the plan what it requires

    Number of letters, who may write them, what they must state, and whether there is a validity window.

  3. Check the letter names the right procedure and the right surgeon

    Letters are generally non-transferable: one written for a specific surgeon and procedure often will not satisfy a plan reviewing a different one, even for the same person.

  4. Check the date

    Around eighteen months is a commonly applied window. A letter that was fine when written can be stale by the time surgery is scheduled.

  5. Get letters re-issued rather than argued about

    A refreshed letter is usually faster than an appeal about whether an old one still counts.

Where requirements are loosening

Colorado Medicaid moved to a single provider letter for surgery, removed the 60-day pre-surgery letter window, and dropped the counseling requirement for hormones. Requirements are not uniform, and an older description of what is needed may overstate it.

Common questions

Can I reuse a letter for a different surgeon?
Often not. Letters are commonly written naming a surgeon and procedure, and plans and surgeons both read them that way. Ask before assuming.
How long is a letter good for?
There is no universal answer. Roughly eighteen months is a commonly applied window; your plan and surgeon each have their own view.

Better covered elsewhere

Where to go next

Sources for the legal points on this page

Health First Colorado expanded gender-affirming care in 2023

Colorado Medicaid · effective 2023-08-30

Health First Colorado benefit expansion, 2023-08-30 — NOT VERIFIED. Three routes tried and each failed for a different reason: direct fetch is CloudFront geo-blocked (403, non-US traffic); the IPRoyal residential proxy exits in Colorado but blocks .gov domains at the proxy itself; and the Wayback Machine holds no snapshot after the August 2023 expansion (its newest capture of the page is a 404). Clearing this needs someone on a normal US connection to read the page

Status: contested · source-checked 2026-08-06 · primary source verified: never

Last updated 2026-08-06Not legal or medical advice