Important Information About Inpatient Sterilization Claims

On April 15, 2023, NC Medicaid Clinical Coverage Policy 1E-3 Attachment A Section I-b page 19 Non-Covered Services was revised. Please review the following important information related to inpatient sterilization claims.

When submitting a claim for a beneficiary for whom a valid consent form is not available or for a beneficiary in a population group for whom the state cannot provide a sterilization:

The provider should select diagnosis codes that do not include the sterilization and should NOT report the ICD-10 procedure code for the noncovered procedure on their claim, allowing the DRG to calculate appropriately.

These claims must be submitted according to the instructions in clinical coverage policy 1E-3 Sterilization Procedures, Attachment A, Section I. 2.

Federal guidelines for coverage are available in 42 CFR Part 441, Subpart F.