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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 2. Medicaid Title XIX family planning services : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.8 Sterilization and Sterilization-Related Procedures : 2.2.8.3 Occlusive Sterilization Device

2.2.8.3
Procedure code A4264 may be reimbursed for the occlusive sterilization system (micro-insert), and may be reimbursed separately from the surgery (procedure code 58565) to place the device.

Texas Medicaid & Healthcare Partnership
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