Sterilization and hysterectomy are covered health care services for Washington Apple Health (Medicaid) enrollees.
Updated Sterilization Consent Form
The Sterilization Consent Form (HHS-687) was updated in July 2025 (expires July 2028) and is now available on our website. You can find it under the “Claims” heading on our Provider Billing and Claims page and our Provider Forms & Tools page.
On August 4, 2025, the Washington State Health Care Authority (HCA) advised:
Effective immediately, providers must use the updated form when obtaining initial consent for sterilization procedures. If the client has already provided initial consent (completion of Sections I, II, and III) on the expired version of HHS-687, it is not necessary to start the process over with a new form. HHS-687 forms with expiration date July 31, 2025, will be accepted for sterilization claims with a date of service on or before January 31, 2026. HCA sent out a Provider Alert with this information on August 1, 2025.
More information is available in the HCA’s Washington Apple Health (Medicaid) Sterilization Billing Guide dated July 1, 2025, in CHPW’s Provider Manual, and below.
CHPW Billing Guidelines
A properly completed Sterilization Consent Form (HHS-687) is required for all sterilization-related claims. This includes hospital claims and professional services (surgeon and anesthesia).
All other requirements and instructions for the Sterilization Consent Form must be followed to ensure the consent form is valid. Please see the Washington Apple Health (Medicaid) Sterilization Billing Guide for additional information, “Coverage and Payment” section and “Appendix A: Consent form instructions.”
Hysterectomy also requires a completed, valid consent form, and all inpatient services require prior authorization. A sterilization consent form is a separate form and is not the correct form for hysterectomies. The Hysterectomy Consent Form (HCA 13-365) is the correct, required form for hysterectomies. Please see the Washington Apple Health (Medicaid) Physician-Related Services/Health Care Professional Services Billing Guide, Hysterectomies section, for additional information.
CHPW will not pay for sterilization or hysterectomy services without a consent form. Payment will be reduced if a valid sterilization or hysterectomy claim does not have a completed, signed consent form.
As stated in the Sterilization Billing Guide:
- HCA will deny claims with a primary purpose of sterilization.
- When labor/delivery (including C-section) and a sterilization are performed during the same hospital stay, HCA pays only for the labor/delivery (including C-section) if the sterilization did not comply with the informed consent requirement.
- For hospital claims priced by ratio of costs-to-charges, the hospital must indicate on the claim all charges that are associated with the sterilization on their own line with the appropriate revenue code as noncovered. The hospital must add the following note to the claim: “Sterilization charges moved to noncovered.”
- Use of a modifier (such as GZ) at line level will result in claim denial if the provider does not indicate a noncovered amount.
- For hospital claims priced by diagnosis-related group, it is not necessary for the hospital to indicate sterilization services as noncovered on the claim. HCA will review each claim to identify sterilization-related codes (surgical, diagnosis, and revenue). HCA will manually reprice the claims to remove payment for sterilization.
For purposes of this CHPW communication, use of “sterilization” in the above quote from the HCA billing guide includes hysterectomy.
In addition:
- Hospitals priced by ratio of cost to charges (RCC): CHPW will reimburse the hospital for covered labor/delivery charges. If the claim is not billed correctly, it will be denied for proper billing and the provider would need to submit a corrected claim.
- Hospitals priced by diagnosis related group (DRG) have a different calculation method. CHPW will reduce the payment of the claim by removing the sterilization services.
Please see the CHPW Provider Manual, “Women’s Health Care” section, for more information. Consent forms are available under the “Claims” heading on our Provider Billing and Claims page and our Provider Forms & Tools page.
If you have any questions or need assistance, please contact [email protected].
