Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 433.000 - Physician Services
Section 433.458 - Sterilization Services: Consent Form Requirements
Universal Citation: 130 MA Code of Regs 130.433
Current through Register 1531, September 27, 2024
Informed consent for sterilization must be documented by the completion of the MassHealth agency's Consent for Sterilization form in accordance with the following requirements.
(A) Required Consent Form.
(1) One of the following
Consent for Sterilization forms must be used:
(a) CS-18 - for members 18 through 20 years
of age; or
(b) CS-21 - for members
21 years of age or older.
(2) Under no circumstances will the
MassHealth agency accept any other consent for sterilization form.
(B) Required Signatures. The member, the interpreter (if one was required), and the person who obtained the consent for sterilization must all sign and date the Consent for Sterilization form (CS-18 or CS-21) at the time of consent. After performing the sterilization procedure, the physician must sign and date the form.
(C) Required Distribution of the Consent Form. The Consent for Sterilization form (CS-18 or CS-21) must be completed and distributed as follows:
(1) the original must be given to the member
at the time of consent; and
(2) a
copy must be included in the member's permanent medical record at the site
where the sterilization is performed.
(D) Provider Billing and Required Submissions.
(1) All providers
must bill with the appropriate sterilization diagnosis and service codes, and
must attach a copy of the completed Consent for Sterilization form (CS-18 or
CS-21) to each claim made to the MassHealth agency for sterilization services.
This provision applies to any medical procedure, treatment, or operation for
the purpose of rendering an individual permanently incapable of reproducing.
When more than one provider is billing the MassHealth agency (for example, the
physician and the hospital), each provider must submit a copy of the completed
sterilization consent form with the claim.
(2) A provider does not need to submit a
Consent for Sterilization form (CS-18 or CS-21) with a claim for a medical
procedure, treatment, or operation that is not for the purpose of rendering an
individual permanently incapable of reproducing. If the appropriate service
code used to bill for such a medical procedure, treatment, or operation is also
used to bill for a sterilization, the claim will be denied unless at least one
of the following justifications is present and documented on an attachment
signed by the physician and attached to the claim.
(a) The medical procedure, treatment, or
operation was a unilateral procedure and did not result in
sterilization.
(b) The medical
procedure, treatment, or operation was unilateral or bilateral, but the patient
was previously sterile as indicated in the operative notes.
(c) The medical procedure, treatment, or
operation was medically necessary for treatment of an existing illness or
injury and was not performed for the purpose of sterilization; or
(d) The medical procedure, treatment, or
operation was medically necessary for treatment of a life-threatening emergency
situation and was not performed for the purpose of sterilization, and it was
not possible to inform the member in advance that it would or could result in
sterilization. Include the nature and date of the life-threatening
emergency.
(3) In the
circumstances set forth in 130 CMR 433.458(D)(2)(a) and (c), the medical
records must also document that the member consented to the medical procedure,
treatment, or operation after being informed that it would or could result in
sterilization.
(4) When more than
one provider is billing the MassHealth agency under the circumstances specified
in 130 CMR 433.458(D)(2) (for example, the physician and the hospital), each
provider must submit a copy of the signed attachment along with the
claim.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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