SECTION 354.1073. Authorized Outpatient Hospital Services

Outpatient hospital services include diagnostic, therapeutic, rehabilitative, or palliative items or services furnished by or under the direction of a physician except that no payment is made for:

(1) drugs and biologicals which are self-administered;

(2) occupational therapy that is not medically prescribed treatment designed to improve or restore an individual's ability to perform those tasks required for independent functioning in self-care activities for eating, personal hygiene, dressing, and communication;

(3) outpatient services from a Title XIX hospital which provides these services without charge upon payment of a registration fee. The registration fee is paid instead of any other benefits for services;

(4) parenteral hyperalimentation therapy unless prior authorization is received from the department's health insuring agent. These services must be considered medically necessary in order to sustain life. Coverage does not extend to hyperalimentation administered as a nutritional supplement.

Source Note: The provisions of this §354.1073 adopted to be effective May 30, 1977, 2 TexReg 1929; amended to be effective February 11, 1983, 8 TexReg 331; amended to be effective November 1, 1983, 8 TexReg 4290; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561