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.

Source Note: The provisions of this §21.2427 adopted to be effective September 7, 2021, 46 TexReg 5571.