28 Texas Administative Code (TAC) §134.503, Pharmacy Fee Guideline applies to reimbursement of prescription drugs and nonprescription drugs or over-the-counter medications as defined in §134.500 (relating to Definitions) for outpatient use in the Texas workers' compensation system, which includes:
- network claims;
- non-network claims; and
- certain government employee workers’ compensation claims (Labor Code §504.053(b)(2).
Note: The pharmacy fee guideline does not apply to parenteral drugs. Parenteral drugs are reimbursed using the methodology in the Medical Fee Guideline for Professional Services [28 TAC, §134.203(d)] for non-network claims, or by a workers’ compensation network contract for network claims.
28 TAC Chapter 133 General Medical Provisions, Subchapter B Health Care Provider Billing Procedures applies to pharmacy bill submission.
If billing on paper, use the Statement of Pharmacy Services (DWC066).