TMPPM 2008 > Texas Medicaid Services > Family Planning Services > Procedure Codes and Reimbursement Amounts

20.7.8.3 Vasectomy

Procedure code 1/2-55250 should be used for any sterilization procedure performed on a male by a family planning agency using Title V, X, XIX, or XX. This procedure code is paid as a global fee to include preoperative, intraoperative, and postoperative services by all parties involved (i.e., physician, anesthesiologist, facility, laboratory, etc.). Vasectomies are considered to be permanent, once-per-lifetime procedures. When a client's claim history shows a previous vasectomy, providers will be asked to appeal and must provide supporting documentation for the need for repeat sterilization. Per federal regulation 42 CFR 50, Subpart B, all sterilization procedures require an approved Sterilization Consent Form.

Refer to: "Sterilization Consent Form (English)" and "Sterilization Consent Form (Spanish)".

"Sterilization Consent Form and Instructions" .