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DSS-MS-146 Revised 10/11 MEDICAID STERILIZATION CONSENT FORM NOTICE YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY PROGRAM OF PROJECTS RECEIVING FEDERAL FUNDS. CONSENT TO STERILIZATION I have asked for and received information about sterilization from.

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At least 21 years old at the time the Consent for Sterilization form is signed. Voluntarily sign the Consent for Sterilization (PDF) form (MHCP will not accept a consent form signed by a guardian, conservator or anyone other than the person to be sterilized.)

A completed PM 330 Sterilization Consent Form must accompany all claims directly related to the sterilization surgery. This requirement extends to all providers, attending physicians, surgeons, assistant surgeons, anesthesiologists and facilities.

Medical devices are sterilized in a variety of ways including using moist heat (steam), dry heat, radiation, ethylene oxide gas, vaporized hydrogen peroxide, and other sterilization methods (for example, chlorine dioxide gas, vaporized peracetic acid, and nitrogen dioxide).

Sterilization is any medical or surgical procedure intended to render the client permanently incapable of reproducing. This includes vasectomies (CPT® code 55250), tubal ligations (CPT® codes 58600, 58605, 58611, 58615, 58670, and 58671), and hysteroscopic sterilizations (CPT® code 58565).

The CPT-code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/ or salpingectomy)) and ICD-10 code Z30. 2 (Encounter for sterilization are the appropriate codes for the bilateral salpingectomy) are the appropriate preventive codes for a bilateral salpingectomy.

Procedure Code 58700 - Open procedures Fallopian Tubes, with/without ovaries salpingectomy, complete or partial, unilateral or bilateral (separate procedure). Bilateral tubal ligation (BTL) is a benefit under Texas Medicaid for sterilization under the appropriate circumstances.

CPT® 58670, Under Laparoscopic Procedures on the Oviduct/Ovary. The Current Procedural Terminology (CPT®) code 58670 as maintained by American Medical Association, is a medical procedural code under the range - Laparoscopic Procedures on the Oviduct/Ovary.

The Current Procedural Terminology (CPT®) code 58611 as maintained by American Medical Association, is a medical procedural code under the range - Incision Procedures on the Oviduct/Ovary.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232