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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 1 General Information : 1.3 NP, CNS, PA, and CNM Claims Submitted by a Physician

Physicians will be reimbursed 92 percent of the established reimbursement rate for services provided by an NP, CNS, PA, or CNM if the physician does not make a decision regarding the client’s care or treatment on the same date of service as the billable medical visit. Physicians who submit a claim using the physician’s own provider identifier for the services that were provided by the NP, CNS, PA, or CNM must submit one of the following modifiers on each claim detail:

Texas Medicaid & Healthcare Partnership
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