TMPPM 2008 > Texas Medicaid Services > Physician > Benefits and Limitations

36.3.5 Hospital Visits

36.3.5.1 Nonintensive Care

Hospital visits are limited to one per day for the same provider.

Only one initial hospital care visit may be considered for reimbursement to the same provider within a 30-day period regardless of diagnosis. Additional hospital visits within the 30 days are considered for reimbursement as subsequent care visits.

An initial hospital care visit submitted within three days of a new patient office, home, nursing facility, or skilled nursing facility (SNF) visit, for the same or similar diagnosis submitted by the same provider, should be submitted as a subsequent care visit.

Refer to: "Prolonged Physician Services" .