Highmark Medical Policy Bulletin
Section: Surgery
Number: S-103
Topic: Reversal of Sterilization Procedures
Effective Date: August 28, 2000
Issued Date: August 28, 2000
Date Last Reviewed:

General Policy Guidelines

When a benefit, payment may be made for reversal of sterilization procedures and eligible related services (i.e., medical care, consultations, diagnostic procedures, anesthesia, etc.). Payment may also be made for the treatment of complications arising from reversal of sterilization.

Procedure Codes

554005875058752   

Traditional (UCR/Fee Schedule) Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Benefits are not provided for the reversal of a voluntary surgical sterilization.

Also refer to General Policy Guidelines

Comprehensive/Wraparound/PPO Guidelines

Refer to General Policy Guidelines

Managed Care (HMO/POS) Guidelines

Refer to General Policy Guidelines

Publications

References

View Previous Versions

No Previous Versions

Table Attachment


Text Attachment

Procedure Code Attachment


Glossary

TermDescription





Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.