SECTION 355.8581. Reimbursement Methodology for Family Planning Services

(a) Family planning services described in 25 TAC Chapter 56 (relating to Family Planning) are reimbursed as follows:

(1) For physician and other practitioner services, physician-administered drugs and biologicals, and the administration of immunizations, providers are reimbursed the lesser of:

(A) the provider's billed charges; or

(B) fees determined by the Texas Health and Human Services Commission in accordance with §355.8085 of this subchapter (relating to Reimbursement Methodology for Physicians and Other Practitioners).

(2) Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) are reimbursed in accordance with §355.8023 of this subchapter (relating to Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)).

(b) Fees for family planning services and items are adjusted within available funding as described in §355.201 of this title (relating to Establishment and Adjustment of Reimbursement Rates by the Health and Human Services Commission).

Source Note: The provisions of this §355.8581 adopted to be effective September 29, 1987, 12 TexReg 3223; amended to be effective January 15, 1993, 18 TexReg 67; 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 December 1, 2012, 37 TexReg 7749; amended to be effective December 1, 2017, 42 TexReg 5431