Tex. Ins. Code Section 1451.126
Reimbursement for Physical Modalities and Procedures by Health Insurer, Administrator, Health Maintenance Organization, or Preferred Provider Benefit Plan Issuer

(a)

A health insurer or licensed third-party administrator may not deny reimbursement to a health care practitioner for the provision of covered services of physical modalities and procedures that are within the scope of the practitioner’s practice if the services are performed in strict compliance with:

(1)

laws and rules related to that practitioner’s license; and

(2)

the terms of the insurance policy or other coverage agreement.

(b)

A health maintenance organization or preferred provider benefit plan issuer may not deny reimbursement to a participating health care practitioner for services provided under a coverage agreement solely because of the type of practitioner providing the services if the services are performed in strict compliance with:

(1)

laws and rules related to that practitioner’s license; and

(2)

the terms of the insurance policy or other coverage agreement.

(c)

This section may not be construed to circumvent any contractual provider network agreement between a health insurer or third-party administrator and a licensed health care practitioner.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Source: Section 1451.126 — Reimbursement for Physical Modalities and Procedures by Health Insurer, Administrator, Health Maintenance Organization, or Preferred Provider Benefit Plan Issuer, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1451.­htm#1451.­126 (accessed Jun. 5, 2024).

1451.001
Definitions 1451.051
Applicability of Subchapter 1451.052
Applicability of General Provisions of Other Law 1451.053
Practitioner Designation 1451.054
Terms Used to Designate Health Care Practitioners 1451.101
Definitions 1451.102
Applicability of Subchapter 1451.103
Conflicting Provisions Void 1451.104
Nondiscriminatory Payment or Reimbursement 1451.105
Selection of Acupuncturist 1451.106
Selection of Advanced Practice Nurse 1451.107
Selection of Audiologist 1451.108
Selection of Chemical Dependency Counselor 1451.109
Selection of Chiropractor 1451.110
Selection of Dentist 1451.111
Selection of Dietitian 1451.112
Selection of Hearing Instrument Fitter and Dispenser 1451.113
Selection of Licensed Clinical Social Worker 1451.114
Selection of Licensed Professional Counselor 1451.115
Selection of Surgical Assistant 1451.116
Selection of Marriage and Family Therapist 1451.117
Selection of Nurse First Assistant 1451.118
Selection of Occupational Therapist 1451.119
Selection of Optometrist 1451.120
Selection of Physical Therapist 1451.121
Selection of Physician Assistant 1451.122
Selection of Podiatrist 1451.123
Selection of Psychological Associate 1451.124
Selection of Psychologist 1451.125
Selection of Speech-language Pathologist 1451.126
Reimbursement for Physical Modalities and Procedures by Health Insurer, Administrator, Health Maintenance Organization, or Preferred Provider Benefit Plan Issuer 1451.127
Duty of Person Arranging Provider Contracts for Health Insurer or Health Maintenance Organization 1451.128
Selection of Pharmacist 1451.151
Definition 1451.152
Applicability and Construction of Subchapter 1451.153
Use of Optometrist or Therapeutic Optometrist 1451.154
Participation of Therapeutic Optometrist 1451.155
Contracts with Optometrists or Therapeutic Optometrists 1451.156
Certain Conduct Prohibited 1451.157
Extrapolation Prohibited 1451.158
Enforcement of Subchapter 1451.201
Definitions 1451.202
Applicability and Construction of Subchapter 1451.203
Conflicting Provisions 1451.204
Certain Conduct Permitted 1451.205
Disclosure of Benefit Terms 1451.206
Payment or Reimbursement of Dentist 1451.207
Prohibited Conduct 1451.208
Prior Authorization of Dental Care Services 1451.209
Requirements for Third Party Access to Provider Networks 1451.251
Definition 1451.252
Applicability of Subchapter 1451.253
Exception 1451.254
Rules 1451.255
Right of Female Enrollee to Select Obstetrician or Gynecologist 1451.256
Direct Access to Services of Obstetrician or Gynecologist 1451.257
Availability of Providers 1451.258
Notice of Available Providers 1451.259
Limits on Physician Sanctions 1451.260
Administrative Penalty 1451.301
Applicability of General Provisions of Other Law 1451.302
Dietitian Services 1451.351
Loss of Income Benefits for Disability Treatable by Podiatrist 1451.401
Contract with Osteopathic Hospital 1451.402
Services at Osteopathic Hospital 1451.403
Request for Action of Commissioner 1451.404
Enforcement 1451.451
Reimbursement Under Medicaid-based Fee Schedule 1451.501
Definitions 1451.502
Applicability of Subchapter 1451.503
Exception 1451.504
Physician and Health Care Provider Directories 1451.505
Physician and Health Care Provider Directory on Internet Website 1451.1261
Reimbursement for Certain Services and Procedures Performed by Pharmacists 1451.2065
Contracts with Dentists
Green check means up to date. Up to date

Accessed:
Jun. 5, 2024

§ 1451.126’s source at texas​.gov