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TITLE 28 - INSURANCE
PART 1 - TEXAS DEPARTMENT OF INSURANCE
CHAPTER 21 - TRADE PRACTICES
SUBCHAPTER P - MENTAL HEALTH AND SUBSTANCE USE DISORDER PARITY
SECTION/RULE §21.2427 - Plan Reimbursement Rates Compared with Medicare Rates
Chapter Review Date 06/08/2021

(a) Reporting worksheet. An issuer must report the data required by this section within the "MH/SUD Parity Rule Division 2 Data Collection Reporting Form" template in the worksheet titled "Reimbursement Rates."(b) Categories of providers and billing codes. An issuer must report average plan reimbursement rates separately for in-network and out-of-network providers for services provided by the following categories of providers for the billing codes specified by TDI in the worksheet:(1) orthopedic surgeons;(2) cardiologists;(3) internists;(4) endocrinologists;(5) gastroenterologists;(6) neurologists;(7) pediatricians;(8) dermatologists;(9) psychiatrists;(10) psychologists;(11) licensed clinical social workers;(12) podiatrists;(13) chiropractors;(14) occupational therapists; and(15) physical therapists.

Source Note: The provisions of this §21.2427 adopted to be effective September 7, 2021, 46 TexReg 5571.

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