1 Tex. Admin. Code § 355.8549 - Reimbursement to Hospitals and Physicians Who Dispense Drugs

(a) Reimbursements to licensed physicians who dispense their own drugs and to hospitals with outpatient pharmacies are based on actual invoice cost, verifiable by audit, plus a dispensing fee assigned by the Texas Health and Human Services Commission (HHSC) or the provider's usual and customary charge to the general public, whichever is lower.

(b) HHSC separately reimburses a hospital provider who provides outpatient department (OPD) services for any non-opioid treatment, as defined by Texas Human Resources Code § 32.03117, when provided as part of an OPD service to a Medicaid recipient.

Notes

1 Tex. Admin. Code § 355.8549

The provisions of this §355.8549 adopted to be effective November 16, 1987, 12 TexReg 3553; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 1997, as published in the Texas Register December 11, 1998, 23 TexReg 12660; Amended by Texas Register, Volume 49, Number 48, November 29, 2024, TexReg 9744, eff. 11/28/2024