Sterilization

Medicare covers sterilization only when it is medically necessary to treat an illness or injury and the primary objective is treatment (examples: hysterectomy for uterine tumor, bilateral oophorectomy for diseased ovaries, bilateral orchiectomy for prostate cancer). Elective sterilization procedures or sterilization performed as a preventive measure (including to avoid pregnancy-related risk or mental-condition risk) are not covered. Claims must include pathological evidence of necessity in the medical record or they will be denied on postpay review and payments recouped.

"Sterilization is covered when performed as necessary treatment of an illness or injury and the primary objective is treatment rather than achieving sterilization."

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