1 Tex. Admin. Code § 355.8161 - Reimbursement Methodology for Midwife Services
(a) Certified Nurse Midwives. Covered
professional services provided by a certified nurse midwife (CNM) are
reimbursed the lesser of the CNM's billed charges or 92 percent of the
reimbursement for the same professional service paid to a physician (M.D. or
D.O.). The claim for reimbursement must either be:
(1) billed under the CNM's provider number;
or
(2) a physician claim indicating
that the physician was supervising the activity of the CNM and did not, on the
date the service was rendered, make a decision about the patient's
care.
(b) CNMs are
reimbursed at the same reimbursement level as physicians for laboratory
services, x-ray services, and injections.
(c) Licensed Midwives. Effective for services
delivered on and after January 1, 2013, covered professional services provided
by a licensed midwife (LM) and billed under the LM's provider number are
reimbursed the lesser of the LM's billed charges or 70 percent of the
reimbursement for the same professional service paid to a physician (M.D. or
D.O.).
Notes
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