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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 4. Certified Registered Nurse Anesthetist (CRNA) : 4.4 Claims Filing and Reimbursement : 4.4.2 Reimbursement

4.4.2
A CRNA is reimbursed the lesser of either the CRNA’s billed charges or 92 percent of the reimbursement for the same service paid to a physician (MD or DO) anesthesiologist in accordance with 1 TAC §355.8221.
Texas Medicaid implemented mandated rate reductions for certain services. The OFL and static fee schedules include a column titled “Adjusted Fee” to display the individual fees with all mandated percentage reductions applied. Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
Note:
Certain rate reductions including, but not limited to, reductions by place of service, client type program, or provider specialty may not be reflected in the Adjusted Fee column.
Refer to:
Subsection 8.2.6.8, “Reimbursement Methodology,” in this handbook for more information about flat fees and time based fees.

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