Library: Policy
317:30-5-51. Elective sterilizations
Issued 7-27-95
(a) Payment is made to hospitals for elective sterilizations performed in behalf of eligible individuals if all of the following circumstances are met:
- (1) The patient must be at least 21 years of age at the time the consent form is signed,
- (2) The patient must be mentally competent,
- (3) A properly completed Federally mandated consent for sterilization form is attached to the claim, and
- (4) The form is signed by the patient at least 30 days, but not more than 180 days prior to the surgery.
(b) When a sterilization procedure is performed in conjunction with a C-section, it is considered multiple surgery and a consent form for the sterilization is required.
(c) Reversal of sterilization procedures for the purposes of conception are not covered. Reversal of sterilization procedures may be covered when medically necessary and substantiating documentation is attached to the claim.
