TMPPM 2008 > Texas Medicaid Services > Federally Qualified Health Center (FQHC) > Reimbursement

21.2.1 Medicare-Medicaid Crossover Claims Pricing

For FQHC Medicare-Medicaid crossover claims, the Texas Medicaid Program pays the difference between the Medicaid encounter rate and any Medicare payment up to a maximum of the Medicaid encounter rate. If the Medicare payment is larger, no payment is made by Medicaid.