TMPPM 2011 > Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook > Geneticists > Enrollment > Geneticists

5.1.1 Geneticists

Geneticists may enroll in Texas Medicaid as both a physician or physician group and as a geneticist. Enrollment as a geneticist allows enhanced reimbursement for specific procedure codes when a claim is submitted using the geneticist provider identifier.

A provider of genetic services that wishes to enroll in Texas Medicaid as a geneticist must complete the required Medicaid provider enrollment application forms and enter into a written agreement with HHSC. Texas Medicaid provider enrollment forms are available from TMHP, and may be downloaded on the TMHP website at www.tmhp.com. Completed applications are submitted to:

Texas Medicaid & Healthcare Partnership
Provider Enrollment
PO Box 200795
Austin, TX 78720

Prior to enrollment, applicant qualifications for the provision of genetic services are verified and approved by DSHS. Verification and approval are administered through the Health Screening & Case Management Unit, 1-512-458-7111, Ext. 2193. Basic contract requirements are as follows:

•The provider's medical director must be a clinical geneticist (MD or DO) who is licensed by the Texas Medical Board (TMB) and who is board-eligible or certified by the American Board of Medical Geneticists (ABMG).

•The provider must use a team of professionals to provide genetic evaluative, diagnostic, and counseling services. The team rendering the services must consist of professional staff including the clinical geneticist and at least one of the following: nurse, social worker, medical geneticist, or genetic counselor.

•Upon DSHS approval, TMHP issues a provider identifier and a performing provider identifier for the provision of genetic services.

•Providers cannot be enrolled if their license is due to expire within 30 days; a current license must be submitted.