Notes about the table:
- Current fee guidelines are in bold, prior fee guidelines are in italics.
- Where available, links point to the Texas Register archives on the Texas Secretary of State and University of North Texas websites.
Guideline / description | Rule citation | Applicable for dates of service | Proposal published in Texas Register | Adoption published in Texas Register |
---|---|---|---|---|
Ambulatory Surgical Center Fee Guideline This fee guideline applies to facility medical services provided in a licensed ambulatory surgical center. |
§134.402 |
On and after September 1, 2008 |
8/22/08 (current rule) |
|
Ambulatory Surgical Center Fee Guideline |
§134.402 |
From December 30, 2007 through August 31, 2008 |
||
Ambulatory Surgical Center Fee Guideline |
§134.402 |
From March 10, 2005 through November 30, 2007 |
||
Ambulatory Surgical Center Fee Guideline |
§134.402 |
From May 9, 2004 through March 9, 2005 |
||
Dental Fee Guideline This fee guideline applies to professional dental services |
§134.303 |
On and after June 15, 2005 |
6/3/05 (current rule) |
|
Dental Fee Guideline |
§134.202 [Dental Fee Guideline located at (c)(4)] |
From August 1, 2003 through June 14, 2005 |
||
Dental Fee Guideline |
§134.302 |
From April 1, 1996 through July 31, 2003 |
||
Hospital Facility Fee Guidelines - Inpatient This fee guideline applies to facility medical services provided in an inpatient acute care hospital. |
§134.404 |
On and after March 1, 2008 |
1/11/08 (current rule) |
|
Hospital Facility Fee Guidelines - Inpatient |
§134.400 repeal |
Repealed effective August 1, 1997 |
||
Hospital Facility Fee Guidelines - Inpatient |
§134.400 |
From September 1, 1992 through July 31, 1997 |
||
Acute Care Inpatient Hospital Fee Guideline |
§134.401 repeal |
Repealed effective July 13, 2008 |
||
§134.401 |
From August 4, 1997 through February 29, 2008 |
2/11/97 | 7/4/97 | |
Hospital Facility Fee Guidelines - Outpatient This fee guideline applies to facility medical services provided to an outpatient in an acute care hospital. |
§134.403 |
On and after March 1, 2008 |
1/11/08 (current rule) |
|
Medical Fee Guideline for Professional Services This fee guideline applies to professional medical services such as services provided by a doctor. |
§134.203 |
On and after March 1, 2008 |
1/11/08 (current rule) |
|
Medical Fee Guideline for Professional Services |
§134.202 (also contained Dental Fee Guideline at (c)(4) through 6/14/05) |
From August 1, 2003 through February 29, 2008 |
||
Medical Fee Guideline for Professional Services |
§134.201 (commonly called the 1996 Medical Fee Guideline; also contained Pharmacy Fee Guideline) |
From April 1, 1996 through July 31, 2003 |
||
Medical Fee Guideline for Professional Services |
§134.201 repeal (commonly called the 1991 Medical Fee Guideline) |
Repealed effective April 1, 1996 |
||
Medical Fee Guideline for Professional Services
|
§134.201 (commonly called the 1991 Medical Fee Guideline) |
From December 11, 1991 through March 31, 1996 |
||
Medical Fee Guidelines for Workers' Compensation Specific Services This fee guideline applies to professional medical services that are specific to the Texas workers' compensation system. |
§134.204 (previously included in §134.202) |
On and after March 1, 2008 through August 31, 2016 |
||
Applicability Rules §§134.209 -134.250 were previously included in §134.204 |
§134.209 |
Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. |
07/01/16 (current rule) |
|
Medical Fee Guideline for Workers' Compensation Specific Services |
§134.210 |
Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. |
07/01/2016 (current rule) |
|
Home Health Services |
§134.215 |
Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. |
07/01/16 (current rule) |
|
Case Management Services |
§134.220 |
Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. |
07/01/16 (current rule) |
|
Functional Capacity Evaluations |
§134.225 |
Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. |
07/01/16 (current rule) |
|
Return to Work Rehabilitation Programs | §134.230 | Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. | 03/18/16 | 07/01/16 (current rule) |
Return to Work/Evaluation of Medical Care | §134.235 | Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. | 03/18/16 | 07/01/16 (current rule) |
Billing for Work Status Reports | §134.239 | Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. | 03/18/16 | 07/01/16 (current rule) |
Designated Doctor Examinations | §134.240 | Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. | 03/18/16 | 07/01/16 (current rule) |
Maximum Medical Improvement Evaluations and Impairment Rating Examinations | §134.250 | Applies to workers' compensation specific codes, services, and programs provided on or after September 1, 2016. | 03/18/16 | 07/01/16 (current rule) |
Medical Reimbursement / Use of the Fee Guidelines This rule provides initial instructions for concepts used in calculating reimbursement for medical treatments and services. |
§134.1 |
On and after March 1, 2008 |
1/11/08 (current rule) |
|
Medical Reimbursement / Use of the Fee Guidelines |
§134.1 |
From May 2,2006 through February 29, 2008 |
||
Medical Reimbursement / Use of the Fee Guidelines |
§134.1 repeal |
Repealed effective May 1, 2006 |
4/28/06 | |
Medical Reimbursement / Use of the Fee Guidelines |
§134.1 |
From May 16, 2002 through May 1, 2006 |
||
Pharmaceutical Benefits Definitions | §134.500 | On and after April 13, 2018 for all DOIs | 01/19/18 | 04/13/18 (current rule) |
Pharmaceutical Benefits Definitions | §134.500 | On and after January 17, 2011 for all DOIs | 7/16/10 | 12/17/10 |
Pharmaceutical Benefits Definitions |
§134.500 |
On and after January 3, 2002 |
||
Initial Pharmaceutical Coverage This rule provides instruction for pharmacy benefits for the first seven days following an injury. |
§134.501 |
On and after November 7, 2002 |
11/1/02 (current rule) |
|
Pharmaceutical Services This rule provides instructions for prescribing doctors and pharmacists. |
§134.502 |
On and after March 21, 2014 |
03/21/14 (current rule) |
|
Pharmaceutical Benefits |
§134.502 |
From January 1, 2003 through March 20, 2014 |
||
Pharmaceutical Benefits |
§134.502 |
From January 3, 2002 through December 31, 2002 |
||
Pharmacy Fee Guideline This rule provides the methodology for calculating reimbursement for pharmaceutical benefits excluding inpatient drugs and parenteral drugs. |
§134.503 | On and after October 23, 2011 | 7-1-11 | 10-14-11 (current rule) |
Pharmacy Fee Guideline This rule provides the methodology for calculating reimbursement for pharmaceutical benefits excluding inpatient drugs and parenteral drugs. |
§134.503 | On and after January 1, 2011 | Emergency Rule | 12/31/10 |
Reimbursement Methodology |
§134.503 |
On and after March 14, 2004 |
||
Reimbursement Methodology |
§134.503 |
From January 3, 2002 through March 13, 2004 |
||
Pharmacy Fee Guideline |
§134.201 (previously part of Medical Fee Guideline) |
From April 1, 1996 through March 1, 2002 |
||
Pharmacy Fee Guideline | §134.201 (previously part of Medical Fee Guideline) | From December 11, 1991 through March 31, 1996 | 09/10/91 | 11/29/91 |
Pharmaceutical Expenses Incurred by the Injured Employee This rule provides the procedure for injured employees to be reimbursed for certain out-of-pocket expenses related to prescription medication. |
§134.504 |
On and after March 14, 2004 |
3/5/04 (current rule) |
|
Pharmaceutical Expenses Incurred by the Injured Employee |
§134.504 |
From January 3, 2002 through March 13, 2004 |
||
Outpatient Open Formulary for Claims with Dates of Injury Prior to September 1, 2011 Continues the Open formulary for use with "legacy' claims. |
§134.506 | On and after January 1, 2011 for claims with a DOI prior to September 1, 2011 | 7/16/10 | 12/17/10 (current rule) |
Outpatient Drug Formulary This rule adopted the open formulary defined in §134.500. |
§134.506 |
On and after January 3, 2002 |
||
Transition to the Use of the Closed Formulary for Claims with Dates of Injury Prior to September 1, 2011 | §134.510 | On and after September 1, 2011 for claims with a DOI prior to September 1, 2011 | 7/16/10 | 12/17/10 (current rule) |
Outpatient Closed Formulary for Dates of Injury on or After September 1, 2011 | §134.520 | Applies to claims with DOIs on or after September 1, 2011 beginning September 1, 2011; and then applies to all claims on and after September 1, 2013 | 7/16/10 | 12/17/10 (current rule) |
Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks | §134.530 | Applies to non-network claims on or after April 13, 2018 | 01/19/18 | 04/13/18 (current rule) |
Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks | §134.530 | Applies to non-network claims with DOIs on or after September 1, 2011 beginning September 1, 2011 through April 12, 2018 | 7/16/10 | 12/17/10 |
Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks | §134.540 | Applies to network claims on or after April 13, 2018 | 01/19/18 | 04/13/18 (current rule) |
Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks | §134.540 | Applies to network claims with DOIs on or after September 1, 2011 beginning September 1, 2011 through April 12, 2018 | 7/16/10 | 12/17/10 |
Medical Interlocutory Order | §134.550 | On and after September 1, 2011 | 7/16/10 | 12/17/10 (current rule) |
Incentive Payments for Workers' Compensation Underserved Areas This rule provides the ZIP codes in Texas that have been designated as medically underserved for workers' compensation purposes. This rule is used only with §§ 134.203 and 134.204 |
§134.2 |
On and after March 1, 2008 |
1/11/08 (current rule) |