Prior Auth Required

01164 - Any procedure resulting in sterilization: Requires submission of the Consent for Sterilization form (F- ) with the claim

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceAny procedure resulting in sterilization: Requires submission of the Consent for Sterilization form (F- ) with the claim
Procedure / Service Description

Notification Requirements The requirement for notification is the responsibility of the participating - completed within 24 hours Any procedure resulting in sterilization: Requires submission of the Consent for Sterilization form (F-01164) with the claim; which is available on the Forward Health Portal.

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.