Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 15 - NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS
Section 355.8281 - Reimbursement Methodology for Nurse Practitioners and Clinical Nurse Specialists
Universal Citation: 1 TX Admin Code ยง 355.8281
Current through Reg. 49, No. 38; September 20, 2024
(a) Covered professional services provided by a nurse practitioner (NP) or a clinical nurse specialist (CNS) are reimbursed the lesser of the NP's or CNS' billed charges or 92 percent of the reimbursement for the same professional service paid to a physician (M.D. or D.O.). The claim for reimbursement must either be:
(1) billed under the NP's or CNS' provider
number; or
(2) a physician claim
noting that the physician was supervising the activity of the NP or CNS and did
not, on the date the service was rendered, make a decision about the patient's
care.
(b) NPs and CNSs are reimbursed at the same reimbursement level as physicians for laboratory services, x-ray services, and injections.
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