Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 32 - CLINICAL LABORATORY SERVICES
Section 355.8610 - Reimbursement for Clinical Laboratory Service

(1) The lower of the provider's usual customary charge for that service or a maximum fee determined by the Texas Health and Human Services Commission (HHSC), or its designee.

(2) Fees for services provided will be established at a percentage of the Medicare fee schedule.

(1) For services provided on and after the date that the modernized Medicaid Management Information System (MMIS) becomes operational, providers will be reimbursed based on an outpatient prospective payment system (OPPS). The OPPS used for reimbursement is the 3MT Enhanced Ambulatory Patient Groups (EAPG) calculator. EAPGs are a visit-based classification system intended to reflect the type of resources utilized in outpatient encounters for patients with similar clinical characteristics.

(2) For services provided prior to the date that the modernized MMIS becomes operational, the lower of the provider's usual customary charge for that service or a maximum fee determined by HHSC, or its designee. Fees for services provided will be established at a percentage of the Medicare fee schedule.