Tubal Ligation. The charges for tubal ligations.
Tubal Ligation. In accordance with West Virginia Code § 9-5-12(d), the DHHR shall make payment for tubal ligation without requiring at least 30 days between the date of informed consent and the date of the tubal ligation procedure. Tubal ligation services for which the MCO is not responsible for payment are excluded from MCOs’ capitation rates but will remain covered Medicaid and WVCHIP services for persons who are enrolled in MCOs. DHHR shall pay claims for tubal ligation on an FFS basis in accordance with West Virginia Department of Health and Human Resources, Bureau for Medical Services Policy 519.15, Women’s Health Services. Any licensed doctor providing these services must be compliant with the Federal Social Security Act 42 CFR §441, Subpart F – Sterilizations, §441.255 and §441.256 requirements, which requires informed consent and medical necessity.
Tubal Ligation v. Vasectomy.
Tubal Ligation. When using a network provider, eighty percent (80%) of charges. When using a non-network provider, sixty percent (60%) of UCR/Allowed Amount. (See 20.05(E) for OPM; see 20.06(A) for Deductibles that apply). One hundred percent (100%) coverage after OPM is reached. Not covered if performed incidental during another procedure.
Tubal Ligation. See 35.03 (H) for co-payments; see 35.03 (C) for deductibles. When using a PPO provider, 100% of charges after OPM. When using a non-PPO provider, 100% of UCR/Allowed Amount after OPM. (See 35.03 (C), for OPM; see 35.03 (E) for UCR/Allowed Amount. Note that there is a $250 penalty charge for Ohio Med PPO or Traditional Plus Program members who utilize non-PPO hospitals on a non-emergency basis; see 35.03 (H). However, not covered as incidental if performed during another procedure.
Tubal Ligation. Tubal ligation services are provided upon payment of a $20.00 Supplemental Charge per visit. When provided in a hospital-based setting or Ambulatory Surgery Center (ASC), tubal ligation services are provided upon payment of the Supplemental Charge specified in section A-2. When provided while hospitalized (e.g. immediately following delivery), tubal ligation services are provided upon payment of the Supplemental Charge specified in section B.
Tubal Ligation. In accordance with Senate Bill 716, the DHHR shall make payment for tubal ligation without requiring at least 30 days between the date of informed consent and the date of the tubal ligation procedure. Tubal ligation services are excluded from MCOs’ capitation rates but will remain covered Medicaid services for persons who are enrolled in MCOs. DHHR shall pay claims for tubal ligation on an FFS basis in accordance with West Virginia Department of Health and Human Resources, Bureau for Medical Services Policy 519.15, Women’s Health Services. Any licensed doctor providing these services must be compliant with the Federal Social Security Act 42 CFR §441, Subpart F – Sterilizations, §441.255 and §441.256 requirements, which requires informed consent and medical necessity.
