SECTION 355.8161. Reimbursement Methodology for Midwife Services

(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.).

Source Note: The provisions of this §355.8161 adopted to be effective September 3, 1985, 10 TexReg 3178; amended to be effective September 1, 1988, 13 TexReg 3829; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; duplicated 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 January 1, 2013, 37 TexReg 8466; amended to be effective December 28, 2014, 39 TexReg 9887