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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 3. Women’s Health Program (Title XIX Family Planning) : 3.3 Services, Benefits, Limitations, and Prior Authorization : 3.3.8 Sterilization and Sterilization-Related Procedures : 3.3.8.4 Facility Fees for Sterilization

3.3.8.4
Hospital-based and freestanding ASCs may be reimbursed for procedure code 58565, 58600, 58615, 58670, 58671, or A4264. An appropriate WHP diagnosis code must be billed when reporting facility fees related to tubal ligation.
Refer to:
Section 5, “Ambulatory Surgical Center and Hospital 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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