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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 : WHP Services After Sterilization
A hysterosalpingogram is recommended three months after a hysteroscopic sterilization procedure to ensure tubal occlusion. Procedure code 74740 and 58340 are considered for reimbursement in this circumstance when billed with diagnosis code V252.
Federally qualified health center (FQHC) and rural health center (RHC) providers may bill procedure codes 99201 and 99211 with an appropriate WHP diagnosis code to receive their encounter reimbursement for follow-up services to confirm the sterilization of WHP clients. FQHC providers may be reimbursed up to three encounter rates per calendar year, per client. RHC providers may be reimbursed one encounter rate per calendar year, per client for family planning visits provided through WHP.

Texas Medicaid & Healthcare Partnership
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