TMPPM 2008 > Texas Medicaid Services > Physician Assistant (PA) > Reimbursement

37.2 Reimbursement

According to 1 TAC §355.8093, the Medicaid rate for PAs is 92 percent of the rate paid to a physician (doctor of medicine [MD] or doctor of osteopathy [DO]) for the same service and 100 percent of the rate paid to physicians for laboratory services, X-ray services, and injections. Services performed by a PA and billed under a physician's or RHC's provider identifier are reimbursed according to the Texas Medicaid Reimbursement Methodology (TMRM) for physician services.

Fee schedules are available on the TMHP website at www.tmhp.com/file library/file library/fee schedules. To request a hard copy, call the TMHP Contact Center at 1-800-925-9126.

Procedures billed by PAs are reviewed retrospectively for medical necessity. Independently enrolled PAs with a valid Medicare provider number are eligible to receive payment of deductible and coinsurance amounts as appropriate on Medicare crossover claims.

Refer to: "Provider Enrollment" for more information.

"TMHP Electronic Data Interchange (EDI)" for information on how to obtain electronic fee schedules from the TMHP website.