Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 7 - AMBULATORY SURGICAL CENTERS
Section 355.8121 - Reimbursement to Ambulatory Surgical Centers
Current through Reg. 49, No. 38; September 20, 2024
(a) For dates of service 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).
(b) For services provided prior to the date that the modernized MMIS becomes operational, subject to the specifications, conditions, and limitations established by the Texas Health and Human Services Commission, payment for ambulatory surgical center facility services is made based on Medicare rules and prospectively determined rates, unless otherwise specified by the department.
(c) Payment for services provided in or by an ambulatory surgical center, other than ambulatory surgical center facility services, is made under other provisions of the state plan, as appropriate to the service and the provider performing the service.
(d) Physicians must bill the Medicaid Program separately for services they provide in an ambulatory surgical center.
