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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook : 3 Obstetric Services : 3.1 *Services, Benefits, Limitations, and Prior Authorization : 3.1.3 Elective Deliveries Prior to 39 Weeks

3.1.3
Texas Medicaid restricts any Cesarean section, labor induction, or any delivery following labor induction to one of the following criteria:
Note:
Records are subject to retrospective review. Payments made for Cesarean section, labor induction, or any delivery following labor induction that fail to meet these criteria (as determined by review of medical documentation), are subject to recoupment. Recoupment may apply to all services related to the delivery, including additional physician fees, birthing center, and inpatient and outpatient hospital fees.

Texas Medicaid & Healthcare Partnership
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