Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter A - ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM
PAYMENT FOR HOSPITAL SERVICES
Section 1163.61 - Payment conditions for hysterectomies
Universal Citation: 55 PA Code ยง 1163.61
Current through Register Vol. 54, No. 44, November 2, 2024
Payment is made for a hysterectomy if:
(1) The hysterectomy is performed for a valid medical reason other than sterilization.
(2) Except as stated otherwise in subparagraphs (i) and (ii), the individual and her representative, if any, has been advised orally and in writing, that the hysterectomy will render the individual permanently incapable of reproducing. The individual or her representative, if any, must sign a Patient Acknowledgement Form for Hysterectomy which acknowledges receipt of that information unless one of the following occurs:
(i) The individual is
already sterile at the time of the hysterectomy and the physician who performs
the hysterectomy certifies in writing that the individual was sterile prior to
the procedure and states the cause of the sterility. The reasons may include,
but are not limited to congenital disorders, a previous sterilization or
postmenopausal sterility.
(ii) The
individual requires a hysterectomy because of a life-threatening emergency
situation in which the physician determines that prior acknowledgement is not
possible. The physician must include a description of the nature of the
emergency, documenting that prior acknowledgement was not possible.
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