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19.2.4.3 Reimbursement
Noncustom DME may be reimbursed at the lower of the billed amount, the amount allowed by the Centers for Medicare & Medicaid Services (CMS), when available, or the amount allowed by Texas Medicaid.
Expendable medical supplies may be reimbursed at the lower of the billed amount, the amount allowed by CMS, when available, or Texas Medicaid.
Ambulatory surgical centers (ASCs) may be reimbursed at the lower of the billed amount or the amount allowed by Texas Medicaid based on ASC groupings approved by CMS.
Inpatient hospital care may be reimbursed at 80 percent of the rate authorized by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) for a total of 60 days per calendar year.
Orthotics and prosthetics may be reimbursed at the lower of the billed amount or the amount allowed by CMS, when available, or Texas Medicaid.
Physicians may be reimbursed at the lower of the billed amount or the amount allowed by Texas Medicaid.
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