Provider Alert! Physician services provided in outpatient hospital settingsTexas Children's Health Plan
Effective October 1, 2019, physician services furnished in outpatient hospital settings that are ordinarily provided in a physician office will be reimbursed at a rate of 60% of the Texas Medicaid rate as outlined in Section 9.5.3 Reimbursement of the Texas Medicaid Provider Procedures Manual (TMPPM).
Providers should verify impacted procedures and Place of Service (POS) codes to determine appropriate payment for covered services. The applicable procedure codes for those services include, but are not limited to: 99201-99205, 99211-99215, and 99281-99283.
Next steps for providers: Providers should reference www.tmhp.com/pages/topics/rates.aspx for more information on the Texas Medicaid mandated rate reductions.