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Static Fee Schedules

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The files on this page contain the Texas Medicaid fee schedules for the selected federal fiscal quarter. These fee schedules provide a view of the fees that were in effect during the first seven days of the selected quarter for the Medicaid program. If you are a Texas Medicaid provider and you have an active account on TMHP.com, you can limit the fee schedules that appear to those that apply to your provider identifier. Click here to log on to your account and select which provider identifier you want to use.

If you do not have an account on TMHP.com, but you know which fee schedules you need, you can select the appropriate Excel or PDF file. If you do not know which fee schedules apply to you, the system can help you find them. Select a provider type and provider specialty from the drop-down menus, and then click Search. The applicable fee schedules will be displayed.

To view past fee schedules, click the archive link at the bottom of the screen.

Multiple worksheets 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.

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Provider Type  
Provider Specialty  
DescriptionExcel FilePDF FileFile NameModified Date
   
AMBULANCE PRCR416C 1/13/2017
AMBULATORY SURGICAL CENTER (ASC) / HOSPITAL - BASED AMBULATORY SURGICAL CENTER (HASC) PRCR405C 1/13/2017
AMBULATORY SURGICAL CENTER (ASC) / HOSPITAL - BASED AMBULATORY SURGICAL CENTER (HASC) - Insert PRCR405C_I 1/13/2017
AUDIOLOGIST PRCR437C 1/13/2017
BIRTHING CENTER PRCR447C 1/13/2017
CASE MANAGEMENT AND REHABILITATIVE SERVICES - BLIND CHILDREN'S VOCATIONAL DISCOVERY AND DEVELOPMENT PROGRAM PRCR425C 1/13/2017
CASE MANAGEMENT AND REHABILITATIVE SERVICES - CHILDREN AND PREGNANT WOMEN PRCR424C 1/13/2017
CASE MANAGEMENT AND REHABILITATIVE SERVICES - EARLY CHILD INTERVENTION PRCR427C 1/13/2017
CASE MANAGEMENT AND REHABILITATIVE SERVICES - MENTAL HEALTH PRCR423C 1/13/2017
CASE MANAGEMENT AND REHABILITATIVE SERVICES - MENTAL RETARDATION PRCR422C 1/13/2017
CERTIFIED NURSE MIDWIFE (CNM) PRCR434C 1/13/2017
CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) / ANESTHESIOLOGIST ASSISTANT (AA) PRCR400C 1/13/2017
CHIROPRACTOR PRCR420C 1/13/2017
CLINICAL LABORATORY PRCR494C 1/13/2017
CLINICAL LABORATORY, AUTOMATED TEST PANELS - Insert PRCR494C_I 1/13/2017
COMPREHENSIVE CARE PROGRAM - PERSONAL CARE SERVICES PRCR498C 1/13/2017
COMPREHENSIVE CARE PROGRAM - PRIVATE DUTY NURSING PRCR499C 1/13/2017
COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF) / OUTPATIENT REHABILITATION FACILITY (ORF) PRCR411C 1/13/2017
DENTAL PRCR496C 1/13/2017
DENTAL (THSTEPS AND ICF/MR) PRCR407C 1/13/2017
DMEPOS - TOS 9, E, J, L, AND R PRCR704C 1/13/2017
FAMILY PLANNING CLINIC PRCR454C 1/13/2017
HEALTHY TEXAS WOMEN PRCR612C 1/13/2017
HEARING AID AND AUDIOMETRIC SERVICES PRCR414C 1/13/2017
HOME HEALTH AGENCY PRCR408C 1/13/2017
HOSPITAL OUTPATIENT IMAGING SERVICES PRCR604C 1/13/2017
IN HOME TOTAL PARENTERAL NUTRITION (TPN) SERVICES PRCR448C 1/13/2017
INDIAN HEALTH SERVICES PRCR453C 1/13/2017
LABORATORY INDEPENDENT PRCR429C 1/13/2017
LICENSED CLINICAL SOCIAL WORKER (LCSW) PRCR428C 1/13/2017
LICENSED MIDWIFE PRCR611C 1/13/2017
MEDICAL TRANSPORTATION PRCR705C 1/13/2017
MISCELLANEOUS OTHER PROFESSIONALS - CERTIFIED RESPIRATORY CARE PRACTITIONER PRCR487C 1/13/2017
MISCELLANEOUS OTHER PROFESSIONALS - COMPREHENSIVE HEALTH CENTER (CHC) PRCR450C 1/13/2017
MISCELLANEOUS OTHER PROFESSIONALS - MATERNITY SERVICE CLINIC PRCR449C 1/13/2017
MISCELLANEOUS OTHER PROFESSIONALS - OPTICIAN PRCR432C 1/13/2017
MISCELLANEOUS OTHER PROFESSIONALS - PORTABLE X-RAY, RADIOLOGICAL LAB, PHYSIOLOGICAL LAB PRCR455C 1/13/2017
MISCELLANEOUS OTHER PROFESSIONALS - RADIATION TREATMENT CENTER PRCR441C 1/13/2017
NEPHROLOGY (HEMODIALYSIS, RENAL DIALYSIS) PRCR417C 1/13/2017
NEPHROLOGY (HEMODIALYSIS, RENAL DIALYSIS) - INSERT PRCR417C_I 1/13/2017
NURSE PRACTITIONER/CLINICAL NURSE SPECIALIST PRCR609C 1/13/2017
OCCUPATIONAL THERAPIST PRCR436C 1/13/2017
OPTOMETRIST PRCR403C 1/13/2017
ORAL MAXILLOFACIAL SURGEON PRCR457C 1/13/2017
ORTHODONTIST PRCR456C 1/13/2017
ORTHOTIST PRCR439C 1/13/2017
OUTPATIENT BEHAVIORAL HEALTH PRCR605C 1/13/2017
OUTPATIENT BEHAVIORAL HEALTH - CHEMICAL DEPENDENCYTREATMENT FACILITY PRCR426C 1/13/2017
OUTPATIENT BEHAVIORAL HEALTH - PSYCHOLOGIST PRCR433C 1/13/2017
PHARMACY (NON-DME) DISPENSING FEE PRCR700C 1/13/2017
PHYSICAL THERAPIST PRCR435C 1/13/2017
PHYSICIAN PRCR402C 1/13/2017
PHYSICIAN - ADMINISTERED DRUG/BIOLOGICAL PRCR495C 1/13/2017
PHYSICIAN - ALLERGY PRCR464C 1/13/2017
PHYSICIAN - ANESTHESIOLOGY PRCR466C 1/13/2017
PHYSICIAN - CARDIOVASCULAR DISEASE PRCR467C 1/13/2017
PHYSICIAN - DERMATOLOGY PRCR468C 1/13/2017
PHYSICIAN - DOCTOR OF DENTISTRY PRCR431C 1/13/2017
PHYSICIAN - GASTROENTEROLOGY PRCR469C 1/13/2017
PHYSICIAN - GENERAL SURGERY PRCR463C 1/13/2017
PHYSICIAN - GENETICS PRCR452C 1/13/2017
PHYSICIAN - GERIATRICS PRCR486C 1/13/2017
PHYSICIAN - INTERNAL MEDICINE PRCR470C 1/13/2017
PHYSICIAN - NEPHROLOGY PRCR461C 1/13/2017
PHYSICIAN - NEUROLOGY PRCR471C 1/13/2017
PHYSICIAN - NEUROSURGERY PRCR472C 1/13/2017
PHYSICIAN - NUCLEAR MEDICINE PRCR484C 1/13/2017
PHYSICIAN - OB/GYN PRCR473C 1/13/2017
PHYSICIAN - OPHTHALMOLOGY PRCR474C 1/13/2017
PHYSICIAN - ORTHOPEDIC SURGERY PRCR475C 1/13/2017
PHYSICIAN - OTHER PRCR488C 1/13/2017
PHYSICIAN - OTORHINOLARYNGOLOGY PRCR465C 1/13/2017
PHYSICIAN - PATHOLOGIST PRCR412C 1/13/2017
PHYSICIAN - PEDIATRICS PRCR485C 1/13/2017
PHYSICIAN - PHYSICAL MEDICINE AND REHABILITATION PRCR477C 1/13/2017
PHYSICIAN - PLASTIC SURGERY PRCR476C 1/13/2017
PHYSICIAN - PROCTOLOGY PRCR479C 1/13/2017
PHYSICIAN - PULMONARY DISEASE PRCR480C 1/13/2017
PHYSICIAN - RADIATION THERAPY PRCR481C 1/13/2017
PHYSICIAN - RADIOLOGIST PRCR413C 1/13/2017
PHYSICIAN - THORACIC SURGERY PRCR482C 1/13/2017
PHYSICIAN - UROLOGY PRCR483C 1/13/2017
PHYSICIAN ASSISTANT PRCR607C 1/13/2017
PODIATRIST PRCR404C 1/13/2017
PRESCRIBED PEDIATRIC EXTENDED CARE CENTER PRCR613C 1/13/2017
PROSTHETIST PRCR438C 1/13/2017
REHABILITATIVE SERVICES - MENTAL HEALTH PRCR419C 1/13/2017
RENAL DIALYSIS FACILITY PRCR430C 1/13/2017
RENAL DIALYSIS FACILITY - INSERT PRCR430C_I 1/13/2017
THERAPIES PRCR492C 1/13/2017
THSTEPS - OTHER PRCR451C 1/13/2017
THSTEPS LICENSED VOCATIONAL NURSE PRCR445C 1/13/2017
THSTEPS MEDICAL PRCR415C 1/13/2017
THSTEPS OTHER PRCR442C 1/13/2017
THSTEPS REGISTERED NURSE PRCR444C 1/13/2017
TUBERCULOSIS (TB) CLINIC PRCR459C 1/13/2017
TUBERCULOSIS (TB) CLINIC GROUP PRCR460C 1/13/2017
 
 
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