405 IAC 5-28-9 - Hysterectomy

Current through March 30, 2022

Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-13-7-3; IC 12-15

Sec. 9.

Medicaid reimbursement is available for the performance of hysterectomies with the following restrictions:

(1) Hysterectomy procedures must comply with federal regulations.
(2) A hysterectomy performed solely for the purpose of rendering a woman permanently incapable of reproducing, whether performed as a primary or secondary procedure, is not reimbursable by Medicaid.
(3) The acknowledgement of the hysterectomy information statement must be signed by the member, or member's representative, but is not required where the member is already sterile or where a life-threatening emergency situation exists. Where the hysterectomy is performed on an already sterile member, the physician who performs the hysterectomy must certify in writing that the member was already sterile at the time the hysterectomy was performed and state the cause of the sterility.
(4) Where the hysterectomy is performed under a life-threatening emergency situation, the physician who performed the hysterectomy must certify in writing that the hysterectomy was performed under a life-threatening emergency situation and that prior acknowledgement was not possible. The physician must include a description of the nature of the life-threatening emergency.
(5) The individual must be informed orally and in writing that this procedure will render her permanently incapable of reproducing, and she must sign a written acknowledgement of receipt of this information.
(6) Hysterectomy is subject to prior authorization. Where the hysterectomy is performed under a life-threatening emergency situation, the physician shall notify the office within forty-eight (48) hours of the procedure, not including Saturday, Sunday, and legal holidays, to obtain prior authorization.
(7) All appropriate documentation must be attached to the claim and to claims for directly related services before reimbursement may be made.

Notes

405 IAC 5-28-9
Office ofthe Secretary of Family and Social Services; 405 IAC 5-28-9; filed Jul 25, 1997, 4:00p. m.: 20 IR 3355; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA

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