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December 2016 Texas Medicaid Provider Procedures Manual

Radiology and Laboratory Services Handbook : 3 Radiological and physiological laboratory services : 3.4 Claims Filing and Reimbursement : 3.4.1 Claims Information : 3.4.1.1 Diagnosis Requirements

3.4.1.1
A diagnosis is not required with a provider’s request for payment except when providing the following services:
Claims for all services provided to clients who are eligible for “Emergency Care Only” must have a diagnosis to be considered for reimbursement. As with all procedures billed to Texas Medicaid, most baseline screening or comparison studies are not a benefit.
Refer to:
Section 9, “Physician” in Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) for more information on these services.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.