§ 1163.61. Payment conditions for hysterectomies.
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.
Source The provisions of this § 1163.61 adopted September 23, 1983, effective September 24, 1983, 13 Pa.B. 2881; amended June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185. Immediately preceding text appears at serial page (85052).
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