SECTION 355.8281. Reimbursement 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