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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 2: Texas Medicaid Fee-for-Service Reimbursement : 2.6 Medicare Crossover Claim Reimbursement : 2.6.2 Part B : 2.6.2.1 Exceptions

2.6.2.1
Texas Medicaid reimburses coinsurance liability for MQMB clients on valid, assigned Medicare claims that are within the amount, duration, and scope of the Medicaid program and, if Medicare did not exist, would be covered by Medicaid.
For crossover claims that are submitted by nephrology (hemodialysis, renal dialysis) and renal dialysis facility providers, Texas Medicaid reimburses the Medicare coinsurance and deductible less 5 percent.

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