# 1 Tex. Admin. Code § 355.8023: 1 TAC § 355.8023. Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), DIVISION 2. MEDICAID HOME HEALTH PROGRAM > Texas · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8023 ## Section - **Citation:** 1 Tex. Admin. Code § 355.8023 - **Heading:** 1 TAC § 355.8023. Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), DIVISION 2. MEDICAID HOME HEALTH PROGRAM - **Jurisdiction:** Texas - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Texas Administrative Code / Title 1 ADMINISTRATION / Part 15 TEXAS HEALTH AND HUMAN SERVICES COMMISSION / Chapter 355 REIMBURSEMENT RATES / 1 TAC § 355.8023 ## Text (a) Authorized items provided to eligible Medicaid recipients are reimbursed the lesser of the billed amount or the Medicaid reimbursement rate established by HHSC. (b) HHSC reviews the fees for individual items at least every two years as follows. (1) If Medicare reimburses for a durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) item, the Medicaid reimbursement rate is equal to, or a percentage of, the Medicare reimbursement rate for the procedure code. If HHSC determines that the Medicare reimbursement rate is insufficient, the methodologies in paragraphs (2) or (3) of this subsection apply. (2) If Medicare does not reimburse for a DMEPOS item, other sources are used to determine the Medicaid payment rate as follows: (A) analysis of Medicaid fees for the same or similar items in other states; (B) eighty-two percent of the manufacturer's suggested retail price (MSRP); (C) cost shown on a manufacturer's invoice submitted by the provider to HHSC; or (D) analysis of fees paid under commercial insurance for the same or similar item or service. (3) HHSC may use data sources or methodologies other than those listed in paragraph (2) of this subsection to establish Medicaid fees for DMEPOS when HHSC determines that those methodologies are unreasonable or insufficient. (c) Fees for DMEPOS items are adjusted within available funding as described in §355.201 of this title (relating to Establishment and Adjustment of Reimbursement Rates by the Health and Human Services Commission). ## Nearby sections - [1 Tex. Admin. Code § 355.8001 1 TAC § 355.8001. Reimbursement for Vision Care Services, DIVISION 1. MEDICAID VISION CARE PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8001.md) - [1 Tex. Admin. Code § 355.8021 1 TAC § 355.8021. Reimbursement Methodology for Home Health Services, DIVISION 2. MEDICAID HOME HEALTH PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8021.md) - [1 Tex. Admin. Code § 355.8023 1 TAC § 355.8023. Reimbursement Methodology for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), DIVISION 2. MEDICAID HOME HEALTH PROGRAM](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8023.md) - [1 Tex. Admin. Code § 355.8041 1 TAC § 355.8041. Recipient-Initiated Second Opinions, DIVISION 3. PHYSICIAN SERVICES](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8041.md) - [1 Tex. Admin. Code § 355.8052 1 TAC § 355.8052. Inpatient Hospital Reimbursement, DIVISION 4. 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GENERAL ADMINISTRATION](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8085.md) - [1 Tex. Admin. Code § 355.8087 1 TAC § 355.8087. In-Home Total Parenteral Hyperalimentation Services, DIVISION 5. GENERAL ADMINISTRATION](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8087.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T1_P15_C355_S355_8023. Check the current official text before relying on it. Not legal advice.