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December 2016 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 6 Renal Dialysis Facility : 6.4 Claims Filing and Reimbursement : 6.4.2 Reimbursement

6.4.2
Renal dialysis facilities are reimbursed according to composite rates, which are based on the CMS-specified calculations and the Texas Medicaid Reimbursement Methodology (TMRM). Texas Medicaid may reimburse for dialysis services through either Method I or Method II as defined by CMS.
The hemodialysis, IPD, CAPD and CCPD laboratory and radiology services and the physician supervision of dialysis clients limitations pertain to both Method I and Method II reimbursement.
Texas Medicaid implemented mandated rate reductions for certain services. Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
Refer to:
Section 2.3, “Reimbursement Methodology” (Vol. 1, General Information) for more information about reimbursement.

Texas Medicaid & Healthcare Partnership
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