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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 2: Texas Medicaid Fee-for-Service Reimbursement

Section 2: Texas Medicaid Fee-for-Service Reimbursement
2.1 Payment Information 2-2
2.2 Fee-for-Service Reimbursement Methodology 2-2
2.2.1 Online Fee Lookup (OFL) and Static Fee Schedules 2-2
2.2.2 Cost Reimbursement 2-6
2.2.3 Reasonable Cost and Interim Rates 2-6
2.2.4 Hospitals 2-6
2.2.5 Provider-Specific Visit Rates 2-7
2.2.6 Manual Pricing 2-7
2.3 Reimbursement Reductions 2-7
2.4 Additional Payments to High-Volume Providers 2-7
2.5 Out-of-State Medicaid Providers 2-7
2.6 Medicare Crossover Claim Reimbursement 2-8
2.6.1 Part A 2-8
2.6.2 Part B 2-8
2.6.3 Part C: Medicare Advantage Plans (MAPs) 2-8
2.7 Federal Medical Assistance Percentage (FMAP) 2-9

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.