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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 §355.8549 - Reimbursement to Hospitals and Physicians Who Dispense Drugs
Chapter Review Date 08/06/2024

(a) Reimbursements to licensed physicians who dispense their own drugs and to hospitals with outpatient pharmacies are based on actual invoice cost, verifiable by audit, plus a dispensing fee assigned by the Texas Health and Human Services Commission (HHSC) or the provider's usual and customary charge to the general public, whichever is lower.(b) HHSC separately reimburses a hospital provider who provides outpatient department (OPD) services for any non-opioid treatment, as defined by Texas Human Resources Code §32.03117, when provided as part of an OPD service to a Medicaid recipient.

Source Note: The provisions of this §355.8549 adopted to be effective November 16, 1987, 12 TexReg 3553; 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 November 28, 2024, 49 TexReg 9744.

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