Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 9 - MIDWIVES
Section 355.8161 - Reimbursement Methodology for Midwife Services

Universal Citation: 1 TX Admin Code ยง 355.8161

Current through Reg. 49, No. 38; September 20, 2024

(a) Certified Nurse Midwives. Covered professional services provided by a certified nurse midwife (CNM) are reimbursed the lesser of the CNM's 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 CNM's provider number; or

(2) a physician claim indicating that the physician was supervising the activity of the CNM and did not, on the date the service was rendered, make a decision about the patient's care.

(b) CNMs are reimbursed at the same reimbursement level as physicians for laboratory services, x-ray services, and injections.

(c) Licensed Midwives. Effective for services delivered on and after January 1, 2013, covered professional services provided by a licensed midwife (LM) and billed under the LM's provider number are reimbursed the lesser of the LM's billed charges or 70 percent of the reimbursement for the same professional service paid to a physician (M.D. or D.O.).

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