28 Tex. Admin. Code § 21.2427

Current through Reg. 49, No. 44; November 1, 2024

Section 21.2427 - Plan Reimbursement Rates Compared with Medicare Rates

(a) Reporting worksheet. An issuer must report the data required by this section within the "MH/SUD Parity Rule Division 2 Data Collection Reporting Form" template in the worksheet titled "Reimbursement Rates."

(b) Categories of providers and billing codes. An issuer must report average plan reimbursement rates separately for in-network and out-of-network providers for services provided by the following categories of providers for the billing codes specified by TDI in the worksheet:

(1) orthopedic surgeons;

(2) cardiologists;

(3) internists;

(4) endocrinologists;

(5) gastroenterologists;

(6) neurologists;

(7) pediatricians;

(8) dermatologists;

(9) psychiatrists;

(10) psychologists;

(11) licensed clinical social workers;

(12) podiatrists;

(13) chiropractors;

(14) occupational therapists; and

(15) physical therapists.

28 Tex. Admin. Code § 21.2427

Adopted by Texas Register, Volume 46, Number 36, September 3, 2021, TexReg 5584, eff. 9/7/2021