Jurisdiction E - chrischona2015.orgicare part B

California, Hawaii, Nevada, American Samoa, Guam, north Mariana Islands


Sterilization method any clinical procedure, therapy or procedure for the sole objective of rendering an separation, personal, instance permanently i can not qualify of reproducing and also not pertained to the repair of a damaged/dysfunctional human body part.

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Under the chrischona2015.orgicare regime guidelines the coverage that sterilization is minimal to essential treatment of an illness or injury. An example of important treatment is the removed of a uterus or removed of hurt ovaries (bilateral oophorectomy) since of a tumor, or bilateral orchiectomy in the instance of prostate cancer.

Elective hysterectomy, tubal ligation and vasectomy in the absence of a an illness for i beg your pardon sterilization is considered an reliable treatment are not covered. In addition, no payment would be made for sterilization procedures if that is a preventive measure e.g., a doctor believes pregnancy would certainly cause overall endangerment come a woman"s health, or together a measure up to prevent the possible development of, or impact on a psychological condition, must pregnancy occur. (Section 1862(a)(1)(A) that the Social protection Act and also 42 CFR 411.15(k)).

Claims will certainly be denied on post pay review and also payment recouped if the pathological evidence of the need to perform any kind of of these measures to treat disease or injury is missing and/or when the major objective is to achieve sterilization.

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The following procedures, when used for sterilization to avoid reproduction, will be auto-denied due to the absence of a chrischona2015.orgicare benefit category.

CPT CodeDescription
55250Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)
58600Ligation or transection of fallopian tube(s), ab or quality approach, unilateral or bilateral
58605Ligation or transection of fallopian tube(s), abdominal muscle or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure)
58611Ligation or transection the fallopian tube(s) once done at the moment of cesarean shipment or intra-abdominal surgery (not a different procedure) (list separately in addition to code for major procedure)
58615Occlusion that fallopian tube(s) by machine (eg, band, clip, falope ring) quality or suprapubic approach
58670Laparoscopy, surgical; through fulguration the oviducts (with or there is no transection)
58671Laparoscopy, surgical; with occlusion the oviducts by machine (eg, band, clip, or falope ring)

ICD-10-CM code Z30.2, sterilization must be detailed in item 24E that the CMS-1500 claim form or the electronic equivalent:

ICD-10-CM CodeDescription
Z30.2Encounter because that sterilization