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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER APURCHASED HEALTH SERVICES
DIVISION 5PHYSICIAN AND PHYSICIAN ASSISTANT SERVICES
RULE §354.1067Physician Assistant Benefits and Limitations

(a) Subject to the specifications, conditions, requirements, and limitations established by HHSC or its designee, services performed by a licensed physician assistant are considered for reimbursement if the services:

  (1) are within the scope of practice for a physician assistant, as defined by the licensing board and state law;

  (2) are consistent with rules and regulations promulgated by the Texas State Medical Board ; and

  (3) would be covered by the Texas Medical Assistance Program if provided by a licensed physician (MD or DO).

(b) Services must be reasonable and medically necessary as determined by HHSC or its designee to be considered for reimbursement.

(c) Covered services provided by a physician assistant may be billed under the physician assistant's Texas Medical Assistance Program provider number. Licensed physician assistants who are employed or remunerated by a physician, hospital, facility, or other provider may bill the Texas Medical Assistance Program directly for their services, using the licensed physician assistant provider number. If the services are benefits reimbursed through Medicaid and the physician assistant bills under a licensed physician assistant provider number, payment will be made to the physician assistant.


Source Note: The provisions of this §354.1067 adopted to be effective July 1, 2006, 31 TexReg 5069

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