Library: Policy
317:30-5-18. Elective sterilizations
Revised 9-1-07
(a) Payment is made for elective sterilizations performed in behalf of eligible individuals if all of the following circumstances are met:
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(1) The patient must be at least 21 years of age at the time the consent form is signed;
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(2) The patient must be mentally competent, and not presently institutionalized;
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(3) A properly completed federally mandated consent for sterilization form is attached to the claim; and
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(4) The form is signed and dated at least 30 days, but not more than 180 days prior to surgery.
(b) When a sterilization procedure is performed in conjunction with a C-Section, the appropriate HCPC coding is used to report the procedures performed. A consent form is required when the sterilization procedure is performed.
(c) Reversal of sterilization procedures for the purpose of conception are not covered. Reversal of sterilization procedures may be covered when medically indicated and substantiating documentation is attached to the claim.
