Medicaid Application Fee Requirement by Provider Type

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Byron Black
7 years ago
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1 Medicaid Application Fee Requirement by Provider Type The following table shows which Medicaid provider types are required to pay the application fee upon initial enrollment, re-enrollment, and enrollment of an additional practice location. Note: Providers that are required to pay the application fee but have already paid the fee to Medicare or another state Children s Health Insurance Program (CHIP) or Medicaid program have fulfilled the requirement and are not required to pay the fee to Texas Medicaid. Provider/Supplier Type Ambulance/Air Ambulance Yes Yes Yes Yes No Ambulatory Surgical Center (ASC) Yes Yes Yes Yes No Audiologist No No No No No Birthing Center Yes Yes Yes Yes No Catheterization Lab Yes Yes Yes Yes No Certified Nurse Midwife (CNM) No No No No No Certified Registered Nurse Anesthetist (CRNA) No No No No No Chemical Dependency Treatment Facility Yes Yes Yes Yes No Chiropractor No No No No No Community Mental Health Center Yes Yes Yes Yes No Comprehensive Health Center (CHC) Yes Yes Yes Yes No Comprehensive Outpatient Rehabilitation Facility (CORF) Yes Yes Yes Yes No Dentist/Doctor of Dentistry as a Limited Physician No No No No No Durable Medical Equipment (DME) Yes Yes Yes Yes No Durable Medical Equipment/Home Health Yes Yes Yes Yes No Family Planning Agency Yes Yes Yes Yes No Federally Qualified Health Center (FQHC) Yes Yes Yes Yes No Federally Qualified Look-alike (FQL) Yes Yes Yes Yes No Federally Qualified Satellite (FQS) Yes Yes Yes Yes No Freestanding Psychiatric Facility Yes Yes Yes Yes No

2 Freestanding Rehabilitation Facility Yes Yes Yes Yes No Genetics Yes Yes Yes Yes No HCSSA Yes Yes Yes Yes No Hearing Aid Yes Yes Yes Yes No Home Health Yes Yes Yes Yes No Hospital In-State Yes Yes Yes Yes No Hospital Ambulatory Surgical Center (HASC) Yes Yes Yes Yes No Hospital Military Yes Yes Yes Yes No Hospital Out-of-State Yes Yes Yes Yes No Hyperalimentation Yes Yes Yes Yes No Independent Diagnostic Testing Facility (IDTF) Yes Yes Yes Yes No Independent Lab (No Physician Involvement) Yes Yes Yes Yes No Independent Lab (Physician Involvement) Yes Yes Yes Yes No Licensed Marriage and Family Therapist (LMFT) No No No No No Licensed Professional Counselor (LPC) No No No No No Licensed Midwives No No No No No Maternity Service Clinic (MSC) Yes Yes Yes Yes No Multi-Specialty Group No No No No No Nurse Practitioner/Clinical Nurse Specialist (NP/CNS) No No No No No Occupational Therapist (OT) No No No No No Optician Yes Yes Yes Yes No Optometrist (OD) No No No No No Orthotist Yes Yes Yes Yes No Outpatient Rehabilitation Facility (ORF) Yes Yes Yes Yes No Personal Assistant Services/PCS Yes Yes Yes Yes No Pharmacy Group Immunizations only Yes Yes Yes Yes No

3 Pharmacist Immunizations only No No No No No Physical Therapist (PT) Yes Yes Yes Yes No Physician (MD, DO) No No No No No Physician Assistant No No No No No Physiological Lab Yes Yes Yes Yes No Podiatrist No No No No No Portable X-Ray Yes Yes Yes Yes No Prosthetist Yes Yes Yes Yes No Prosthetist - Orthotist (choose if licensed as both) Yes Yes Yes Yes No Psychologist No No No No No Qualified Rehabilitation Professional (QRP) No No No No No Radiation Treatment Center Yes Yes Yes Yes No Radiological Lab Yes Yes Yes Yes No Renal Dialysis Facility Yes Yes Yes Yes No Respiratory Care Practitioner (CRCP) No No No No No Rural Health Clinic Hospital, Freestanding Yes Yes Yes Yes No Skilled Nursing Facility Yes Yes Yes Yes No Social Worker (LCSW) No No No No No SHARS School, Co-op, or School District No No No No No Specialized/Custom Wheeled Mobility - CCP Yes Yes Yes Yes No Specialized/Custom Wheeled Mobility - Home Health Yes Yes Yes Yes No TB Clinic No No No No No Texas Health Steps (THSteps)-Dental No No No No No THSteps-Medical services provider No No No No No Vision Medical Supplier (VMS) Yes Yes Yes Yes No

4 Case Management Services Blind Children s Vocational Discovery & Development Program No No No No No Case Management for Children and Pregnant Women No No No No No Consumer Directed Services Agency (CDSA) No No No No No Early Childhood Intervention (ECI) Yes Yes Yes Yes No MH Case Management/MR Case Management No No No No No MH Rehab Yes Yes Yes Yes No Service Responsibility Option (SRO) Yes Yes Yes Yes No Women, Infants & Children (WIC) Immunization Only No No No No No Comprehensive Care Program (CCP) Services Dietician No No No No No Licensed Vocational Nurse (LVN) No No No No No Milk Donor No No No No No Occupational Therapist (OT-CCP) No No No No No Pharmacy (DME/Pharmacy CCP) Yes Yes Yes Yes No Physical Therapist (PT-CCP) Yes Yes Yes Yes No Registered Nurse (RN) No No No No No Social Worker (LCSW-ACP) No No No No No Speech Therapist (SLP) No No No No No Medical Transportation Program (MTP) Lodging Yes Yes Yes Yes No Meals Yes Yes Yes Yes No Transportation Service Area Provider (TSAP) No No No No No Individual Transportation Provider (ITP) No No No No No

5 CSHCN Services Program-only Hospice Yes Yes Yes Yes No Medical Foods Supplier Yes Yes Yes Yes No Order/Referring-only provider No No No No No

Texas Medicaid. Rev. XXXI F00106

Texas Medicaid. Rev. XXXI F00106 Texas Medicaid Provider Enrollment Application Rev. XXXI F00106 Introduction Dear Health-care Professional: Thank you for your interest in becoming a Texas Medicaid provider. Participation by providers