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Provider Manual

Sterilization Procedures

Last Updated on May 21, 2020

Family Health Center does not offer coverage for surgical sterilization procedures performed in an ambulatory surgery center, outpatient hospital, inpatient hospital or observation setting. These services will be denied to the patient.

Only services performed in an office setting, such as a vasectomy, will be covered when sterilization criteria below is met. Federal regulations require that the following be in place prior to a covered sterilization procedure:

  • Member must be at least 21 years of age
  • FHC contracted physician must provide a pamphlet from the U.S. Department of Health and Human Services describing the procedure
  • A signed sterilization consent form be on file and accompany the claim upon submission
    • A 30-day waiting period is required from signed consent date until procedure is performed (procedure must be performed 31+ days after signature)
    • The consent form is valid for 180 days after signature
    • There is not a specific consent form required