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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 6 Claims Filing and Reimbursement : 6.2 Reimbursement

The reimbursement methodology for professional services delivered by home health agencies is a statewide visit rate calculated in accordance with 1 TAC §355.8021(a).
Home health agencies are reimbursed for DME and medical supplies in accordance with 1 TAC §355.8021.
PDN services are reimbursed in accordance with 1 TAC §355.8441.
Providers can refer to the OFL or the applicable fee schedule on the TMHP website at
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
Refer to:
Subsection 2.2, “Fee-for-Service Reimbursement Methodology” in “Section 2: Texas Medicaid Fee-for-Service Reimbursement" (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
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