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8.2 Benefits, Limitations, and Authorization Requirements
Services provided by APRNs are benefits if the services are:
• Within the scope of practice for APRNs, as defined by Texas state law.
•Consistent with rules and regulations promulgated by the Texas BON or other appropriate state licensing authority.
•Benefits of the CSHCN Services Program when provided by a licensed physician (doctor of medicine [MD] or doctor of osteopathy [DO]).
•Reasonable and medically necessary as determined by DSHS or its designee.
APRNs who are employed or paid by a physician, hospital, facility, or other provider must not bill the CSHCN Services Program for their services, if the billing results in duplicate payment for the same services.
All limitations applicable to physicians for the same service will also be applied to the APRN.
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