Get the free Sterilization Procedures Clinical Coverage Policy - ncdhhs

This document outlines the clinical coverage policy for sterilization procedures under the Medicaid program, including eligibility criteria, consent requirements, and billing instructions.

How to fill out sterilization procedures clinical coverage

How to fill out Sterilization Procedures Clinical Coverage Policy

1. Read the Sterilization Procedures Clinical Coverage Policy document thoroughly.
2. Identify the required fields that need to be filled out, such as patient information and procedure details.
3. Gather necessary documentation, including consent forms and any relevant medical history.
4. Complete each section of the policy form clearly and accurately.
5. Attach any required supporting documents as specified in the policy.
6. Review the completed form for accuracy and completeness before submission.
7. Submit the form to the appropriate clinical coverage authority as required.

Who needs Sterilization Procedures Clinical Coverage Policy?

1. Patients seeking sterilization procedures.
2. Healthcare providers performing sterilization procedures.
3. Insurance companies processing claims for sterilization services.
4. Policy makers involved in clinical coverage decisions.

People Also Ask about

Will Medicaid pay for sterilization?

“Medicaid covers all medically-necessary sterilization options, including the option with the secondary prophylactic purpose of preventing ovarian cancer.

Does CPT code 58661 require a consent form?

Removal of Fallopian Tubes When one of the above procedures will result in sterilization, a sterilization Consent Form (PM 330) and an approved Treatment Authorization Request (TAR) are required. If CPT codes 58661 and 58700 are elective sterilization procedures, there is no TAR requirement.

How much is sterilization out of pocket?

The bottom line. If you have male reproductive anatomy and are looking for a form of birth control that is permanent and cost effective, you might consider a vasectomy. This form of surgical sterilization typically costs up to $1,000 without insurance. Your out-of-pocket costs are usually less if you have a health plan

Does Medicaid pay for sterilization?

As with FDA-approved reversible methods, the ACA requires coverage under the ACA Medicaid expansion to include surgical and non-surgical sterilization procedures for women. The requirement does not apply to vasectomy for men.

Does Medicare cover female sterilization?

Original Medicare does not cover sterilization to prevent reproduction. Tubal ligation may be covered in rare cases when the procedure is deemed medically necessary — such as an effective treatment for disease. Some Medicare Advantage plans may cover the procedure.

How can I get sterilized for free?

There's a good chance you can get a tubal ligation for free (or at a reduced price) if you have health insurance. Because of the Affordable Care Act (aka Obamacare), most insurance plans must cover all methods of birth control with no cost to you, including some female sterilization procedures.

What is the procedure code for sterilization?

What is sterilization? Sterilization is any medical or surgical procedure intended to render the client permanently incapable of reproducing. This includes vasectomies (CPT® code 55250), tubal ligations (CPT® codes 58600, 58605, 58611, 58615, 58670, and 58671), and hysteroscopic sterilizations (CPT® code 58565).

Does NC Medicaid cover female sterilization?

d. Following is only one of the eligibility and other requirements for participation in the NCHC Program under GS 108A-70.21(a): Children must be between the ages of 6 through 18. Medicaid shall cover sterilization procedures for both men and women age 21 and over. NCHC shall not cover Sterilization Procedures.

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What is Sterilization Procedures Clinical Coverage Policy?

Sterilization Procedures Clinical Coverage Policy outlines the guidelines and requirements for the provision and coverage of sterilization procedures under specific health programs.

Who is required to file Sterilization Procedures Clinical Coverage Policy?

Health care providers and facilities that perform sterilization procedures are required to file the Sterilization Procedures Clinical Coverage Policy.

How to fill out Sterilization Procedures Clinical Coverage Policy?

To fill out the Sterilization Procedures Clinical Coverage Policy, providers must complete the specified forms with accurate patient information, procedure details, and obtain necessary consents.

What is the purpose of Sterilization Procedures Clinical Coverage Policy?

The purpose of the Sterilization Procedures Clinical Coverage Policy is to ensure that sterilization procedures are performed in accordance with legal and medical standards, protecting both patient rights and health care regulations.

What information must be reported on Sterilization Procedures Clinical Coverage Policy?

Information that must be reported includes patient demographics, consent documentation, details of the procedure, and medical necessity justification.