Wiki Medicaid Sterilization Consent Form

[chelsealaible@gmail.com]

Does anyone know what specific surgeries are considered “sterilization” under Medicaid, and would require the consent form to be completed?
Also, it does not sound like the form needs to be completed if the sterilization is being completed as the result of disease process. Does anyone have any background on that?
Thanks so much for any help!

 

[sls314]

Does anyone know what specific surgeries are considered “sterilization” under Medicaid, and would require the consent form to be completed?
Also, it does not sound like the form needs to be completed if the sterilization is being completed as the result of disease process. Does anyone have any background on that?
Thanks so much for any help!

I used to work Medicaid accounts for a hospital here in Ohio. We had to have the sterilization forms completed for all hysterectomies or Ohio Medicaid would not pay. Even when it was for medical reasons. (Which, of course, most hysterectomies are. People aren't typically looking for a hysterectomy specifically for sterilization.) This was about 4 years ago - I don't know if anything has changed since.

We didn't perform other types of sterilization procedures at the facility where I worked, so I have no firsthand familiarity with that.

I was only addressing your point about whether or not the forms could be required when the sterilization was part of a disease process.

 

[chelsealaible@gmail.com]

I used to work Medicaid accounts for a hospital here in Ohio. We had to have the sterilization forms completed for all hysterectomies or Ohio Medicaid would not pay. Even when it was for medical reasons. (Which, of course, most hysterectomies are. People aren't typically looking for a hysterectomy specifically for sterilization.) This was about 4 years ago - I don't know if anything has changed since.

We didn't perform other types of sterilization procedures at the facility where I worked, so I have no firsthand familiarity with that.

I was only addressing your point about whether or not the forms could be required when the sterilization was part of a disease process.

Thanks sls314!

 

[julieordway]

I would advise you to check with your State Medicaid office. I would think you need it for all sterilization cases no matter the indication. In Oregon, they are very specific about the requirement. My experience is with Urology so we have to obtain the consent form for all vasectomies. There are certain guidelines laid out in the form. It has to be signed by both the patient and provider, and interpreter if utilized. It expires after 180 days and they have to receive a consultation visit at least 30 days before the procedure. If these rules aren't met, we don't get paid!
I found this online for New York but not sure if its the most current version: https://www.health.ny.gov/health_care/medicaid/publications/docs/ldss/ldss-3134.pdf

 

[csperoni]

In NY, there are 2 different forms for Medicaid patients commonly used in gyn.
One is a hysterectomy consent form (LDSS-3113) https://www.health.ny.gov/health_care/medicaid/publications/docs/ldss/ldss-3113.pdf
We use this form for any procedure removing the uterus.
It is signed by the patient and the provider unless the patient is already incapable of bearing children, in which case only the provider needs to sign. There are no specific timeframe requirements I am aware of. We typically have this form completed during the appointment discussing a hysterectomy.

The other is a sterilization consent form (LDSS-3134) https://www.health.ny.gov/health_care/medicaid/publications/docs/ldss/ldss-3134.pdf
We use this form only for procedures being done for sterilization purposes. We do not use them for patients having salpingectomies or salpingo-oophorectomies for medical reasons.
This form must be signed by the patient and physician at least 30 days but < 180 days prior to procedure, and then again by the physician following the procedure. When performed in NYC, it must also be witnessed and there are additional requirements about who can obtain the patient consent.

I am not aware of any specific list of CPT codes requiring those forms. EMEDNY gives more complete instructions for both here, but does not list CPT codes. The bulk of my gyn experience is in gynonc and we use the hysterectomy consent form daily, but rarely the sterilization consent form. The NY Medicaid HMOs require these forms as well (Affinity, Fidelis, HealthFirst, UHC Community Plan), so we simply have any hysterectomy patient sign regardless of insurance. I recall nly once getting a denial for a BSO on a patient with an ovarian cyst asking for sterilization form. I simply wrote a letter explaining it was not a sterilization procedure and claim was reprocessed. I think most carriers require the sterilization form based on DIAGNOSIS submitted rather than procedure. And the hysterectomy form is based on procedure.

 

[LRChilders]

I would suggest contacting your local Medicaid representative for state specific requirements. Mississippi Medicaid requirements are ridiculous. We have to have a completed sterilization consent (sterilization consent form and/or hysterectomy consent form) for a hysterectomy, salpingectomy (unilateral and bilateral), oophorectomy, tubal fulgurations/ligations and even endometrial ablations. (even though it is NOT a sterilization procedure) regardless of the indications. If a patient has a hysterectomy, both sterilization and hysterectomy consent forms are required, however if the patient has had a sterilization procedure prior to the hysterectomy (prior tubal, etc) then you only have to submit a hysterectomy consent form. It took several denials, appeals and communication with our local representative to get a complete list for our state.