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The Online Fee Lookup provides fee information for Texas Medicaid, including Texas Health Steps (THSteps), the HHSC Family Planning Program and the CSHCN Services Program. Users can also search for fee information for specified procedure codes.
Texas Medicaid Fee Schedule Information DMEPOS - TOS 9, E, J, L, AND R This fee schedule is intended to be used by a variety of provider types and provider specialties. Some procedure codes might not apply to every provider type and provider specialty designated to use the fee schedule.
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.
Determine the appropriate incurred medical expense (IME) deduction by comparing fees submitted by a durable medical equipment (DME) provider to the fees listed in the DME fee schedule. The Medicare fee schedule for DME contains Healthcare Common Procedural Coding System (HCPCS) codes used by DME providers to file claims.
Payment rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid & Healthcare Partnership (TMHP) website (see Fee Schedules).
The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Provider Handbooks October 2020 Texas Medicaid Provider Procedures Manual Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook
To enroll in the CSHCN Services Program, DME prov iders must be actively enrolled in Texas Medicaid, have a valid CSHCN Services Program Provider Agreement, have completed the CSHCN Services Program enrollment process, and comply with all applicable state laws and requirements.
Based on these rates and reimbursements, PFD is publishing the provider reimbursement rate tables as a transparent resource about reimbursement levels for various Medicaid and non-Medicaid services reimbursed by the state.
All Texas Medicaid Fee Schedules are available at www.tmhp.com. The Texas Medicaid Fee Schedule is categorized by field descriptions. Type of Service (TOS) codes are listed in the first field.
The Texas Medicaid Provider Procedures Manual was updated on September 30, 2024, and contains all policy changes through October 1, 2024. The manual is available in both PDF and HTML formats.