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8.2 Benefits and Limitations
Services provided by APNs are a benefit if the services:
• Are within the scope of practice for APNs, as defined by Texas state law.
•Are consistent with rules and regulations promulgated by the Texas BON or other appropriate state licensing authority.
•Are benefits of the CSHCN Services Program when provided by a licensed physician (doctor of medicine [MD] or doctor of osteopathy [DO]).
•Are reasonable and medically necessary as determined by DSHS or its designee.
APNs who are employed or remunerated by a physician, hospital, facility, or other provider must not bill the CSHCN Services Program for their services, if the billing results in duplicate payment for the same services.
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