Methodology / Rules
The Physician-Administered Drugs program rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 5, Rule 354.106, since Physician-Administered Drugs are considered Physician Services.
The current reimbursement language for Physician-Administered Drugs may be found in the Texas Medicaid Provider Procedures Manual (TMPPM), under the section entitled "Medicaid Reimbursement" and the subsection entitled "Drugs/Biologicals" on the TMHP website: http://www.tmhp.com.
Reimbursement rules applicable to Physician-Administered Drugs are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 5, Rule 8085, since Physician-Administered Drugs are considered Physician Services.
The fee schedules and any periodic adjustment(s) to the fee schedules are published in banner messages contained in provider Remittance and Status (R&S) reports, Medicaid Bulletin articles, web postings, provider manual, fee schedules or other provider notification.
Payment Rate Information
Payment rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid & Healthcare Partnership (TMHP) website (see Fee Schedules).