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December 2016 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

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
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, “Reimbursement Methodology,” in this handbook for more information about flat fees and time based fees.

Texas Medicaid & Healthcare Partnership
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