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

20.7.9 Sterilization Consent Form and Instructions

Per federal regulation 42 CFR 50, Subpart B, all sterilizations require a valid consent form regardless of the funding source. Providers must use the consent form provided in this manual in Appendix B and ensure all required fields are completed for timely processing. These fields are listed in "Required Fields" on page 20-5.

Providers should fax the Sterilization Consent Form five business days before submitting the associated claim(s) to expedite the processing of the Sterilization Consent Form and associated claim(s). Providers must fax fully completed Sterilization Consent Forms to TMHP at 1-512-514-4229. Claims and appeals are not accepted by fax, so providers can send only Family Planning sterilization correspondence to this fax number. Providers should ensure that both Page 1 and Page 2 of the sterilization consent form are faxed together. Failure to do so may delay claim processing or cause the claim to be denied.

Note: Hysterectomy Acknowledgment forms discussed in Section 34 are not sterilization consents and should be faxed to 1-512-514-4218.

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