Skip to main content

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

CSHCN Services Program Provider Manual Update for Payment Methodology for Ambulatory Surgical Centers, Hospital Ambulatory Surgical Centers, and Some Hearing Services

Last updated on

On June 1, 2024, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, Chapter 20: Hearing Services, section 20.5.3 “Reimbursement for Implantable Hearing Devices and Services,” and Chapter 24: Hospital, section 24.5.2 “Reimbursement Information,” to update the payment methodology language for ambulatory surgical centers (ASCs), hospital ambulatory surgical centers (HASCs), and some hearing services.

The following is the updated language:

ASC or HASC Surgery

ASC and HASC surgery payments represent a global payment and include room charges and supplies. Benefit services that are provided are billed as one inclusive charge. All facility services related to the surgery (e.g., laboratory, radiology, anesthesia supplies, and medical supplies) are considered part of the global payment and cannot be itemized or billed separately.

When two or more procedures are performed during the same surgical event, only the procedure with the highest reimbursement rate on the fee schedule will be reimbursed.

Bone-Anchored Hearing Devices and Cochlear Implants

ASCs may be reimbursed with the lower of the billed amount or the maximum fee established by the Texas Health and Human Services Commission.

For more information, call the TMHP-CSHCN Services Program Contact Center at 800-568-2413.