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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 : 2.2.8.6 Facility Fees for Sterilization

2.2.8.6
Hospital-based and freestanding ambulatory surgical centers (HASCs/ASCs) may be reimbursed for procedure code 55200, 55250, 58565, 58600, 58615, 58670, 58671, or A4264. An appropriate family planning diagnosis code must be billed when reporting facility fees for procedure codes 55200, 58565, or 58670.
Refer to:
Form HS.11, “Ambulatory Surgical Center” in the Inpatient and Outpatient Hospital Services Handbook (Vol. 2, Provider Handbooks) for more information about ASC billing procedures.

Texas Medicaid & Healthcare Partnership
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