TMPPM 2008 > Texas Medicaid Services > Hospital (Medical/Surgical Acute Care Facility) > Inpatient

25.2.3.1 Hysterectomy Services

Medically necessary hysterectomies are reimbursable when the physician obtains an appropriate acknowledgment statement from the client. The Texas Medicaid Program does not reimburse for hysterectomies performed for the sole purpose of sterilization.

The physician's signature acknowledging the client's sterility is not required on the claim. The acknowledgment statement must be maintained in the physician's files and is subject to retrospective review. A modifier, PM or PS, must continue to be submitted on the claim or a copy of the signed certification may be attached to the paper claim.

When TMHP receives a valid acknowledgment statement, the client's eligibility file is updated to reflect receipt. Subsequent claims TMHP receives for the hysterectomy are referenced to the acknowledgment statement.

Refer to: "Hysterectomy Acknowledgment Form".