Claim Submission Requirements for Inpatient Sterilization

ForwardHealth covers inpatient surgical sterilization procedures when informed consent requirements are met and the sterilization is provided during the same hospital stay as labor and delivery.

When submitting institutional claims for inpatient sterilizations, providers must:

• Enter the appropriate sterilization diagnosis code or procedure code.
• Enter value code 24 with the monetary charges related to the sterilization.
• Enter the amounts for institutional services related to sterilization in the field for noncovered charges when informed consent and completion requirements are not met.

General Requirements

Providers must fulfill all federal and state requirements and complete the Consent for Sterilization form, DMS-1000 (05/2025), to receive reimbursement.

Charges for services related to sterilization need to be identified on the inpatient claim even when sterilization is not the primary reason for hospitalization.

Providers can also find this form on the Forms page of the ForwardHealth Portal.

Refer to ForwardHealth Online Handbook Sterilizations topics #586 and #1584 for more information about federal and state requirements.