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OFL Search Results

Thank you for your request. Please record the Batch Request ID number(s) below for your records. This Batch ID(s) will allow you to access your search results. Batch results are available within 36 hours.

   
Batch Request ID:
Provider NPI/API Date of Service
Program Date of Search
Claim Type Procedure Code(s)
GeneralDMEClinical Lab

Multiple tabs may display results. For more information, please refer to the Help link.


The fee displayed is the allowable rate for this service. Since September 1, 2011, the Online Fee Lookup (OFL) and static fee schedules include a column titled "Adjusted Fee." The Adjusted Fee column displays the fee with all of the percentage reductions applied. The individual provider payment may differ based on provider type, client type program, place of service, or other factors. For additional information about rates, rules, and procedures, providers can refer to the Texas Medicaid Provider Procedures Manual, Texas Medicaid Bulletins, Texas Medicaid website articles, the CSHCN Services Program Provider Manual, CSHCN Services Program website articles, the rate reduction web page at www.tmhp.com/pages/topics/rates.aspx , and other communications from TMHP or state agencies.

Important: The columns listed for the selected procedure code do not include all benefit limitations. Prior authorization may be required for some procedure codes. Other limitations may apply.

Codes that are not a benefit: Any service that is medically necessary to correct or ameliorate a client's physical or mental issues, disability, or chronic condition is a benefit of THSteps when Federal Financial Participation is available, even if the services are not benefits of Texas Medicaid. This expansion of services only applies to clients who are 20 years of age or younger and eligible to receive THSteps services.

Codes that are not listed in the fee schedules may be reimbursed using a contracted rate. Providers may refer to the Contracted Rate search to determine whether the code is a benefit of Texas Medicaid.

*Providers can click the "View" button in the Benefit Information column to get current articles and information that is based on the procedure code and program that were selected. Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.