Rule 23-202-5.6 - HysterectomyA. The Division of Medicaid defines a hysterectomy as the surgical removal of the uterus. B. The Division of Medicaid covers a hysterectomy when medically necessary in an inpatient or outpatient setting in accordance with current standards of medical practice and when: 1. Prior to the hysterectomy: a) The person who secured authorization to perform the hysterectomy has informed the beneficiary and guardian/legal representative, if any, orally and in writing that the hysterectomy will make the beneficiary permanently incapable of reproducing, and b) The beneficiary or guardian/legal representative, the person that secured authorization for the hysterectomy, and the physician who performs the hysterectomy have completed and signed the appropriate section(s) of the Hysterectomy Acknowledgement Form; 2. The beneficiary is already sterile before the hysterectomy and the physician certifies in writing on the Hysterectomy Acknowledgement Form that the beneficiary was already sterile at the time of the hysterectomy, and states the cause of sterility; or 3. The beneficiary requires a hysterectomy because of a life-threating emergency situation in which the physician determines that prior acknowledgement is not possible, and the physician certifies in writing on the Hysterectomy Acknowledgement Form that the hysterectomy was performed under a life-threatening emergency situation in which he or she determined prior acknowledgement was not possible and documents a description of the nature of the emergency. C. The Division of Medicaid does not cover a hysterectomy when: 1. It is performed solely for the purpose of rendering a beneficiary permanently incapable of reproducing, or 2. There was more than one (1) purpose to the hysterectomy and it would not have been performed but for the purpose of rendering the beneficiary permanently incapable of reproducing.23 Miss. Code. R. 202-5.6
42 CFR § 441.255; Miss. Code Ann. §§ 43-13-117, 43-13-121.Added Miss. Admin. Code Part 202, Rule 5.6.A., B.1-3,C, D eff. 05/01/2014; Moved from Miss. Admin. Code Rule 1.6 and revised eff. 10/01/2013.