TMPPM 2008 > Texas Medicaid Services > Physician Assistant (PA) > Benefits and Limitations

37.3 Benefits and Limitations

Services performed by PAs are covered if the services meet the following criteria:

•Are within the scope of practice for PAs, as defined by Texas state law.

•Are consistent with rules and regulations promulgated by the Texas Medical Board or other appropriate state licensing authority.

•Are covered by the Texas Medicaid Program when provided by a licensed physician (MD or DO).

•Are reasonable and medically necessary as determined by HHSC or its designee.

Services provided to Medicaid clients must be documented in the client's medical record to include:

•Services provided.

•Date of service.

•Pertinent information about the client's condition supporting the need for service.

•The individual practitioner of the service.

PAs who are employed or remunerated by a physician, hospital, facility, or other provider must not bill the Texas Medicaid Program for their services if the billing results in duplicate payment for the same services.

Laboratory (including pregnancy tests) and radiology services provided during pregnancy must be billed separately from antepartum care visits and claims must be received within 95 days from the date of service.

Additional information about benefit limitation for services can be found in the Physician, THSteps, and Family Planning sections of this manual.

Note: Payment to providers for supplies is not a benefit of the Texas Medicaid Program. Costs of supplies are included in the reimbursement for office visits.

Refer to: "Family Planning Services"

"Physician" .

"Texas Health Steps (THSteps)" .