Rates and Billing Assistance

Rate Analysis staff can assist you with questions concerning only payment rates for the specified services. They are not able to answer other types of questions, such as the status of payment for services rendered or anything involving eligibility for care services.

Contact Rate Analysis by email at rateanalysisdept@hhsc.state.tx.us.

To learn more about Federally Qualified Health Centers or Rural Health Clinic program and policy issues, call the TMHP Contact Center at 800-925-9126.

Questions about Billing or Rates? Email cihcpbilling@dshs.state.tx.us.

Federally Qualified Health Center and Rural Health Clinic Rates

Federally Qualified Health Centers provide comprehensive health care services to underserved communities.

A Rural Health Clinic is a clinic located in a rural area designated as a shortage area. It might not exist as a rehabilitation agency or function primarily as a care and treatment facility for mental diseases. Rural Health Clinics are not state licensed nor are they accredited. They might be certified to participate in the federal Medicare Program.

FQHC Rates – effective 12/01/18
RHC Rates - effective 12/01/18

Inpatient Hospital Services

Inpatient hospital services must be medically necessary and be:

  • Provided in an acute care hospital.
  • Provided to hospital inpatients.
  • Provided by or under the direction of a physician.
  • Provided for the care and treatment of patients.

Inpatient Standard Dollar Amount and Ratio of Cost to Charges Rates list is located on the Health and Human Services Commission website at rad.hhs.texas.gov/hospitals-clinic/hospital-services/inpatient-services.

Outpatient Hospital Services

Outpatient hospital services must be medically necessary and be:

  • Provided in an acute care hospital or hospital-based ambulatory surgical center.
  • Provided to hospital outpatients.
  • Provided by or under the direction of a physician.
  • Diagnostic, therapeutic or rehabilitative.

Outpatient RCC Rates list is located on the Health and Human Services Commission website at rad.hhs.texas.gov/hospitals-clinic/hospital-services/outpatient-services.

Physician services

Physician services include those ordered and performed by a physician within the scope of practice of their profession as defined by state law. Physician services must be provided in the doctor's office, the patient’s home, a hospital, a skilled nursing facility or elsewhere.

Payment Standard for Physicians

Use the Fee Schedule for Texas Medicaid Physician at tmhp.com.

Note: If you are unable to locate payment information for a facility, complete and submit Form 111 Facility Payment Rate Request (PDF).