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TO: All Maternity Care Providers

RE: Updated Hysterectomy Consent Form and Administrative Review Process

Effective October 1, 2025, the Alabama Medicaid Agency (Medicaid) will implement a revised Hysterectomy Consent form and administrative review process.

The following changes will be made:

Added language will require the provider to certify the procedure is being performed for the treatment of disease and not for the prevention of disease or prophylaxis.

If the hysterectomy is performed due to unusual circumstances (e.g. already sterile, life-threatening situation, or under a period of retroactive Medicaid eligibility), the consent form and medical records must continue to be submitted to Gainwell through the Alabama Medicaid Interactive Web Portal. Gainwell will send the records to Medicaid for administrative review.  Once a review is complete, a decision regarding the medical necessity of the procedure will be made and the claim will be processed accordingly.

If the hysterectomy is performed in the absence of unusual circumstances, the practice should submit only the completed consent form to Gainwell through the Alabama Medicaid Interactive Web Portal. If the consent is confirmed to be complete, the claim will be processed accordingly.

During a three-month grace period, both consent forms will be accepted. After January 1, 2026, only the new consent form should be used.

The new consent form can be found at the following link:

https://medicaid.alabama.gov/content/9.0_Resources/9.4_Forms_Library/9.4.3_Consent_Forms.aspx

All claims are subject to post-payment review for medical necessity and compliance with Medicaid policies and procedures.

For questions related to the Hysterectomy Consent form and administrative review process, contact Physicians.Program@medicaid.alabama.gov.

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