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26.4 Benefits and Limitations
The Texas Medicaid Program only covers professional and technical services that an independent laboratory is certified by Medicare to perform.
The Texas Medicaid Program pays up to the amount allowed for the total component for the same procedure, same client, same date of service, any provider.
• Providers who perform the technical service and interpretation must bill for the total component.
•Providers who perform only the technical service must bill for the technical component.
•Providers who perform only the interpretation must bill for the interpretation component.
Claims filed in excess of the amount allowed for the total component for the same procedure, same dates of service, same client, any provider, are denied. Claims are paid based on the order in which they are received.
For example, if a claim is received for the total component and TMHP has already made payment for the technical or interpretation component for the same procedure, same dates of service, same client, any provider, the claim for the total component will be denied as previously paid to another provider. The same is true if a total component has already been paid and claims are received for the individual components.
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