Note: This bulletin replaces the Nov. 28, 2022 article, "Sterilization Procedures for Hospital Providers".
The following guidance is to assist hospital providers’ compliance with federal requirements. Consent is required for all voluntary sterilizations including prophylactic bilateral salpingectomy.
The beneficiary shall provide voluntary informed consent according to the requirement found in NC Medicaid clinical coverage policy 1E-3 and the federal regulations listed in 42 CFR 441.253, 42 CFR 441.257 and 42 CFR 441.258. The Sterilization Consent form is available on the U.S. Department of Health & Human Services Office of Population Affairs webpage.
When submitting a claim for a beneficiary for whom a valid consent form is not available or for a beneficiary in a population group for whom the state cannot provide a sterilization, the provider should select diagnosis codes that do not include the sterilization and should NOT report the ICD-10 procedure code for the noncovered procedure on their claim, allowing the DRG to calculate appropriately.
These claims must be submitted according to the instructions in clinical coverage policy 1E-3 Sterilization Procedures, Attachment A, Section I. 2.
Federal guidelines for coverage are available in 42 CFR Part 441, Subpart F.
Contact
NCTracks Call Center: 800-688-6696