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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 28. INSURANCE |
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PART 2. TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION |
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CHAPTER 134. BENEFITS--GUIDELINES FOR MEDICAL SERVICES, CHARGES, AND PAYMENTS |
| SUBCHAPTER A. MEDICAL REIMBURSEMENT POLICIES |
| § 134.1. Medical Reimbursement |
| § 134.2. Incentive Payments for Workers' Compensation Underserved Areas |
| SUBCHAPTER B. MISCELLANEOUS REIMBURSEMENT |
| § 134.100. Reimbursement of Treating Doctor for Attendance at Required Medical Examination |
| § 134.110. Reimbursement of Injured Employee for Travel Expenses Incurred |
| § 134.120. Reimbursement for Medical Documentation |
| § 134.130. Interest for Late Payment on Medical Bills and Refunds |
| § 134.150. Reimbursement of Services Provided by a Federal Military Treatment Facility |
| § 134.155. Federal Military Treatment Facility Disputes |
| SUBCHAPTER C. MEDICAL FEE GUIDELINES |
| § 134.201. Medical Fee Guideline for Medical Treatments and Services Provided under the Texas Workers' Compensation Act |
| § 134.203. Medical Fee Guideline for Professional Services |
| § 134.204. Medical Fee Guideline for Workers' Compensation Specific Services |
| § 134.209. Applicability |
| § 134.210. Medical Fee Guideline for Workers' Compensation Specific Services |
| § 134.215. Home Health Services |
| § 134.220. Case Management Services |
| § 134.225. Functional Capacity Evaluations |
| § 134.230. Return to Work Rehabilitation Programs |
| § 134.235. Return to Work/Evaluation of Medical Care |
| § 134.239. Billing for Work Status Reports |
| § 134.240. Designated Doctor Examinations |
| § 134.250. Maximum Medical Improvement Evaluations and Impairment Rating Examinations |
| § 134.303. 2005 Dental Fee Guideline |
| SUBCHAPTER E. HEALTH FACILITY FEES |
| § 134.402. Ambulatory Surgical Center Fee Guideline |
| § 134.403. Hospital Facility Fee Guideline--Outpatient |
| § 134.404. Hospital Facility Fee Guideline--Inpatient |
| SUBCHAPTER F. PHARMACEUTICAL BENEFITS |
| § 134.500. Definitions |
| § 134.501. Initial Pharmaceutical Coverage |
| § 134.502. Pharmaceutical Services |
| § 134.503. Pharmacy Fee Guideline |
| § 134.504. Pharmaceutical Expenses Incurred by the Injured Employee |
| § 134.506. Outpatient Open Formulary for Claims with Dates of Injury Prior to September 1, 2011 |
| § 134.510. Transition to the Use of the Closed Formulary for Claims with Dates of Injury Prior to September 1, 2011 |
| § 134.520. Outpatient Closed Formulary for Dates of Injury On or After September 1, 2011 |
| § 134.530. Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks |
| § 134.540. Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks |
| § 134.550. Medical Interlocutory Order |
| SUBCHAPTER G. PROSPECTIVE AND CONCURRENT REVIEW OF HEALTH CARE |
| § 134.600. Preauthorization, Concurrent Utilization Review, and Voluntary Certification of Health Care |
| SUBCHAPTER I. MEDICAL BILL REPORTING |
| § 134.800. Applicability |
| § 134.801. Purpose |
| § 134.802. Definitions |
| § 134.803. Reporting Standards |
| § 134.804. Reporting Requirements |
| § 134.805. Records Required to be Reported |
| § 134.806. Records Excluded from Reporting |
| § 134.807. State Specific Requirements |
| § 134.808. Insurance Carrier EDI Compliance Coordinator and Trading Partners |
| SUBCHAPTER J. REVIEWS AND AUDITS |
| § 134.900. Medical Benefit Review and Audit |