Prior Auth Required

01160 - (06/13)) form

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / Service(06/13)) form
Procedure / Service Description

Wisconsin Medicaid - ❍ Hysterectomy claims must be submitted along with an Acknowledgment of Receipt of Hysterectomy Information (F- 01160 (06/13)) form. ❍ Sterilization claims must be submitted along with a paper Consent for Sterilization (F-01164 (10/08)) form.

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.