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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355REIMBURSEMENT RATES
SUBCHAPTER JPURCHASED HEALTH SERVICES
DIVISION 15NURSE PRACTITIONERS AND CLINICAL NURSE SPECIALISTS
RULE §355.8281Reimbursement Methodology for Nurse Practitioners and Clinical Nurse Specialists

(a) Covered professional services provided by a nurse practitioner (NP) or a clinical nurse specialist (CNS) are reimbursed the lesser of the NP's or CNS' 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 NP's or CNS' provider number; or

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

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


Source Note: The provisions of this §355.8281 adopted to be effective January 23, 1991, 16 TexReg 124; amended to be effective May 1, 1993, 18 TexReg 2307; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 1997, as published in the Texas Register December 11, 1998, 23 TexReg 12660; amended to be effective July 1, 2006, 31 TexReg 5073; amended to be effective December 28, 2014, 39 TexReg 9887

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