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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355REIMBURSEMENT RATES
SUBCHAPTER JPURCHASED HEALTH SERVICES
DIVISION 5GENERAL ADMINISTRATION
RULE §355.8093Reimbursement Methodology for Physician Assistants

(a) Covered professional services provided by a physician assistant (PA) are reimbursed the lesser of the PA'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 PA's provider number; or

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

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


Source Note: The provisions of this §355.8093 adopted to be effective July 1, 2006, 31 TexReg 5073; amended to be effective December 28, 2014, 39 TexReg 9887

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