Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 28 - PHARMACY SERVICES: REIMBURSEMENT
Section 355.8549 - Reimbursement to Hospitals and Physicians Who Dispense Drugs

Universal Citation: 1 TX Admin Code § 355.8549

Current through Reg. 50, No. 13; March 28, 2025

(a) Reimbursements to licensed physicians who dispense their own drugs and to hospitals with outpatient pharmacies are based on actual invoice cost, verifiable by audit, plus a dispensing fee assigned by the Texas Health and Human Services Commission (HHSC) or the provider's usual and customary charge to the general public, whichever is lower.

(b) HHSC separately reimburses a hospital provider who provides outpatient department (OPD) services for any non-opioid treatment, as defined by Texas Human Resources Code § 32.03117, when provided as part of an OPD service to a Medicaid recipient.

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