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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 2 Healthy Texas Women (HTW) Program Overview : 2.3 * Services, Benefits, Limitations, and Prior Authorization : 2.3.7 Sterilization and Sterilization-Related Procedures

2.3.7
Sterilizations are considered to be permanent, once per lifetime procedures. Denied claims may be appealed with documentation that supports the medical necessity for a repeat sterilization.
The sterilization services that are available to HTW clients include surgical or nonsurgical sterilization, follow-up office visits related to confirming the sterilization, and any necessary short-term contraception.
HTW covers sterilization as a form of birth control. To be eligible for a sterilization procedure through HTW, the client must be 21 years of age or older and must complete and sign a Sterilization Consent Form within at least 30 days of the date of the surgery but no more than 180 days. In the case of an emergency, there must be at least 72 hours between the date on which the consent form is signed and the date of the surgery. Operative reports that detail the need for emergency surgery are required.

Texas Medicaid & Healthcare Partnership
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