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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 3 Health and Human Services Commission (HHSC) Family Planning Program Services : 3.2 Services, Benefits, Limitations, and Prior Authorization : 3.2.9 Sterilization and Sterilization-Related Procedures : Vasectomy
Procedure code 55250 may be reimbursed for any sterilization procedure performed on a male. Reimbursement for procedure code 55250 includes preoperative, intra-operative, and postoperative services by all parties involved (i.e., physician, anesthesiologist, facility, laboratory, and so on).
Vasectomies are considered to be permanent, once-per-lifetime procedures. If the claim is denied indicating a vasectomy procedure has already been reimbursed for the client, the provider may appeal with documentation that supports the medical necessity for the repeat sterilization.

Texas Medicaid & Healthcare Partnership
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