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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX 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 : Sterilization Consent
Per federal regulation 42 CFR 50, Subpart B, all sterilization procedures require an approved Sterilization Consent Form.
Refer to:
Sterilization Consent Form (Spanish) on the TMHP website at
Sterilization Consent Form Instructions on the TMHP website at

Texas Medicaid & Healthcare Partnership
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