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TITLE 1 - ADMINISTRATION
PART 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 355 - REIMBURSEMENT RATES
SUBCHAPTER J - PURCHASED HEALTH SERVICES
SECTION/RULE §355.8093 - Reimbursement Methodology for Physician Assistants
Chapter Review Date 08/06/2024

(a) Covered professional services provided by a physician assistant (PA) are reimbursed the lesser of the PA'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 PA's provider number; or(2) a physician claim noting that the physician was supervising the activity of the PA and did not, on the date the service was rendered, make a decision about the patient's care.(b) PAs are reimbursed at the same reimbursement level as physicians for laboratory services, x-ray services and injections.

Source Note: The provisions of this §355.8093 adopted to be effective July 1, 2006, 31 TexReg 5073; amended to be effective December 28, 2014, 39 TexReg 9887.

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