CurrentBlue Cross Blue Shield - MainePolicy G-06163

Sterilization, Reimbursement Policy

Governs reimbursement for sterilization procedures performed to render a member permanently incapable of reproducing for Anthem Blue Cross and Blue Shield Medicare Advantage members; applies to participating providers unless contracts or mandates indicate otherwise.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicySterilization, Reimbursement Policy

Policy CodePolicy G-06163

Change TypeNo material changes

Effective DateJun 29, 2022

Next Review Date

Key ActionReimbursement is allowed for sterilization procedures when performed to render a member permanently incapable of reproducing and is paid per the applicable fee schedule or contracted rate.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

covered with criteriacoverage condition

consent not required with claimconsent rule

multiple surgery rulesconcurrent delivery

06/29/2022last approval

Coverage Criteria

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicySterilization, Reimbursement Policy

Policy CodePolicy G-06163

Change TypeNo material changes

Effective DateJun 29, 2022

Next Review Date

Key ActionReimbursement is allowed for sterilization procedures when performed to render a member permanently incapable of reproducing and is paid per the applicable fee schedule or contracted rate.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Sterilization procedure is performed for the purpose of rendering a member permanently incapable of reproducing.

The sterilization is a necessary part of the treatment of an illness or injury.

A valid consent form must be properly executed and include all required signatures: member or member's authorized representative; interpreter, if applicable; person obtaining the member's consent; and the physician performing the sterilization procedure. (Note: an informed consent form does not have to be submitted with claims.)

Do not include the informed consent form with the claim; maintain a properly executed consent form in the medical record.

When the sterilization procedure is performed in conjunction with a delivery, multiple surgery guidelines apply per the Anthem Medicare Advantage Multiple and Bilateral Surgery policy.

Follow multiple and bilateral surgery reimbursement rules when applicable.

Reimbursement Overview & Provider Actions

Billing Rule

Reimbursement Overview

Anthem Medicare Advantage allows reimbursement of sterilization procedures performed to render a member permanently incapable of reproducing when the sterilization is a necessary part of treatment for an illness or injury. Reimbursement is based on the applicable fee schedule or contracted/negotiated rate. If the sterilization is performed in conjunction with a delivery, multiple surgery guidelines apply (see the Anthem Medicare Advantage Multiple and Bilateral Surgery policy). Standard correct coding applies.

Reimbursement allowed when sterilization is necessary part of treatment for illness or injury
Reimbursement basis: applicable fee schedule or contracted/negotiated rate
No claim submission of informed consent required; however a valid consent form must be properly executed and include: member or authorized representative signature, interpreter (if applicable), person obtaining consent, and the physician performing the sterilization
Multiple surgery rules apply when performed with delivery — refer to Multiple and Bilateral Surgery policy
Related coding: standard correct coding applies

Definitions

Sterilization — definition and context

DefinitionSterilization: the process of making a person permanently unable to reproduce.

Developed with reference toPolicy developed considering CMS, State contract, ACOG, and CFR Subpart F sterilization regulations.

Applicable CFR sectionCFR Subpart F - Sterilizations §441.250 - §441.258.

Policy scopeGoverns reimbursement for procedures performed to render a member permanently incapable of reproducing for Anthem Medicare Advantage members.

OpenPayer

Sterilization, Reimbursement Policy

Coverage Criteria

Billing Codes

Reimbursement Overview & Provider Actions

Definitions