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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8 Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) : 8.2 Services, Benefits, Limitations, and Prior Authorization

8.2
Services performed by NPs and CNSs are benefits if the services meet the following criteria:
NPs and CNSs who are employed or remunerated by a physician, hospital, facility, or other provider must not bill Texas Medicaid for their services if the billing results in duplicate payment for the same services.
Physicians who submit a claim using the physician’s own provider identifier for services provided by an NP or CNS must submit modifier SA on each claim detail 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.
Benefit limitation information for services can be found in Section 9, “Physician” in this handbook, the Children’s Services Handbook (Vol. 2, Provider Handbooks), and the Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook (Vol. 2, Provider Handbooks).
Payment for supplies is not a benefit of Texas Medicaid. Costs of supplies are included in the reimbursement for office visits.
Refer to:
Section 2, “Medicaid Title XIX Family Planning Services” in the Gynecological and Reproductive Health and Family Planning Services Handbook (Vol. 2, Provider Handbooks).
Section 9, “Physician” in this handbook.
Section 5: "THSteps Medical" in the Children’s Services Handbook (Vol. 2, Provider Handbooks) for more information on THSteps services.

Texas Medicaid & Healthcare Partnership
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