Jurisdiction E - benidormclubdeportivo.orgicare component B

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


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Sterilization means any clinical procedure, treatment 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 fix of a damaged/dysfunctional body part.

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Under the benidormclubdeportivo.orgicare regime guidelines the coverage of sterilization is minimal to important treatment of an illness or injury. An instance of essential treatment is the removed of a uterus or removal of diseased ovaries (bilateral oophorectomy) because of a tumor, or bilateral orchiectomy in the situation of prostate cancer.

Elective hysterectomy, tubal ligation and also vasectomy in the absence of a disease for which sterilization is taken into consideration an effective treatment space not covered. In addition, no payment would be created sterilization procedures if the is a precautionary measure e.g., a benidormclubdeportivo.orgical professional believes pregnancy would cause in its entirety endangerment come a woman"s health, or together a measure to prevent the feasible development of, or effect on a mental condition, need to pregnancy occur. (Section 1862(a)(1)(A) the the Social security Act and also 42 CFR 411.15(k)).

Claims will certainly be denied on write-up pay review and payment recouped if the pathological proof of the need to perform any type of of these steps to treat disease or injury is missing and/or once the main objective is to achieve sterilization.

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The adhering to procedures, when supplied for sterilization to stop reproduction, will certainly be auto-denied because of the lack of a benidormclubdeportivo.orgicare benefit category.

CPT CodeDescription
55250Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)
58600Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral
58605Ligation or transection that fallopian tube(s), abdominal muscle or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure)
58611Ligation or transection that fallopian tube(s) when done at the time of cesarean shipment or intra-abdominal surgery (not a separate procedure) (list individually in addition to code for main procedure)
58615Occlusion of fallopian tube(s) by device (eg, band, clip, falope ring) vaginal or suprapubic approach
58670Laparoscopy, surgical; through fulguration that oviducts (with or without transection)
58671Laparoscopy, surgical; v occlusion of oviducts by device (eg, band, clip, or falope ring)

ICD-10-CM password Z30.2, sterilization must be provided in item 24E the the CMS-1500 claim kind or the electronic equivalent:

ICD-10-CM CodeDescription
Z30.2Encounter for sterilization