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Texas Administrative Code
Title 28. Insurance
Part 2. Texas Department of Insurance, Division of Workers' Compensation
Old Law Rules
(Injury dates prior to January 1, 1991.)

Chapter 57. Request for Case Folders and Certifications of Actions of the Board -


Chapter 59. Notices of Intention to Appeal

Chapter 67. Allegations of Fraud

Chapter 89. Crime Victims Compensation Act -

New Law Rules
(Injury dates on or after January 1, 1991.)

Chapter 103. Agency Administration -

Subchapter A. Employee Training and Education Program -
Subchapter B. Agency Contracts -
Subchapter C. Resolution of Contract Claims -
Subchapter D. Facilities and Property Management -

Chapter 104. General Provisions—Rule-Making

Chapter 108. Fees -


Chapter 109. Workers’ Compensation Coverage for State Employees

Chapter 133. General Medical Provisions

Subchapter A. General Rules for Medical Billing and Processing
  • § 133.1. Applicability of Medical Billing and Processing§ 133.2. Definitions§ 133.3. Communication Between Health Care Providers and Insurance Carriers§ 133.4. Written Notification to Health Care Providers of Contractual Agreements for Informal and Voluntary Networks§ 133.5. Informal Network and Voluntary Network Reporting Requirements to the Division
  • Subchapter B. Health Care Provider Billing Procedures
  • § 133.10. Required Billing Forms/Formats§ 133.20. Medical Bill Submission by Health Care Provider§ 133.30. Telemedicine and Telehealth Services
  • Subchapter C. Medical Bill Processing/Audit by Insurance Carrier
  • § 133.200. Insurance Carrier Receipt of Medical Bills from Health Care Providers§ 133.210. Medical Documentation§ 133.230. Insurance Carrier Audit of a Medical Bill§ 133.240. Medical Payments and Denials§ 133.250. Reconsideration for Payment of Medical Bills§ 133.260. Refunds§ 133.270. Injured Employee Reimbursement for Health Care Paid§ 133.280. Employer Reimbursement for Health Care Paid
  • Subchapter D. Dispute of Medical Bills
  • § 133.305. MDR—General§ 133.306. Interlocutory Orders for Medical Benefits§ 133.307. MDR of Fee Disputes§ 133.308. MDR of Medical Necessity Disputes§ 133.309. Alternate Medical Necessity Dispute Resolution by Case Review Doctor
  • Subchapter G. Electronic Medical Billing, Reimbursement, and Documentation
  • § 133.500. Electronic Formats for Electronic Medical Bill Processing§ 133.501. Electronic Medical Bill Processing§ 133.502. Electronic Medical Billing Supplemental Data Requirements
  • Chapter 134. Benefits—Guidelines for Medical Services, Charges, and Payments

    Subchapter A. Medical Reimbursement Policies
  • § 134.1. Medical Reimbursement§ 134.2. Incentive Payments for Workers' Compensation Underserved Areas
  • Subchapter B. Miscellaneous Reimbursement
  • § 134.100. Reimbursement of Treating Doctor for Attendance at Required Medical Examination§ 134.110. Reimbursement of Injured Employee for Travel Expenses Incurred§ 134.120. Reimbursement for Medical Documentation§ 134.130. Interest for Late Payment on Medical Bills and Refunds§ 134.150. Reimbursement of Services Provided by a Federal Military Treatment Facility§ 134.155. Federal Military Treatment Facility Disputes
  • Subchapter C. Medical Fee Guidelines
  • § 134.201. Medical Fee Guideline for Medical Treatments and Services Provided Under the Texas Workers' Compensation Act§ 134.203. Medical Fee Guideline for Professional Services§ 134.204. Medical Fee Guideline for Workers' Compensation Specific Services§ 134.209. Applicability§ 134.210. Medical Fee Guideline for Workers' Compensation Specific Services§ 134.215. Home Health Services§ 134.220. Case Management Services§ 134.225. Functional Capacity Evaluations§ 134.230. Return to Work Rehabilitation Programs§ 134.235. Return to Work/Evaluation of Medical Care§ 134.239. Billing for Work Status Reports§ 134.240. Designated Doctor Examinations§ 134.250. Maximum Medical Improvement Evaluations and Impairment Rating Examinations§ 134.303. 2005 Dental Fee Guideline
  • Subchapter E. Health Facility Fees
  • § 134.402. Ambulatory Surgical Center Fee Guideline§ 134.403. Hospital Facility Fee Guideline—Outpatient§ 134.404. Hospital Facility Fee Guideline—Inpatient
  • Subchapter F. Pharmaceutical Benefits
  • § 134.500. Definitions§ 134.501. Initial Pharmaceutical Coverage§ 134.502. Pharmaceutical Services§ 134.503. Pharmacy Fee Guideline§ 134.504. Pharmaceutical Expenses Incurred by the Injured Employee§ 134.506. Outpatient Open Formulary for Claims with Dates of Injury Prior to September 1, 2011§ 134.510. Transition to the Use of the Closed Formulary for Claims with Dates of Injury Prior to September 1, 2011§ 134.520. Outpatient Closed Formulary for Dates of Injury on or After September 1, 2011§ 134.530. Requirements for Use of the Closed Formulary for Claims Not Subject to Certified Networks§ 134.540. Requirements for Use of the Closed Formulary for Claims Subject to Certified Networks§ 134.550. Medical Interlocutory Order
  • Subchapter G. Prospective and Concurrent Review of Health Care
  • § 134.600. Preauthorization, Concurrent Utilization Review, and Voluntary Certification of Health Care
  • Subchapter I. Medical Bill Reporting
  • § 134.800. Applicability§ 134.801. Purpose§ 134.802. Definitions§ 134.803. Reporting Standards§ 134.804. Reporting Requirements§ 134.805. Records Required to be Reported§ 134.806. Records Excluded from Reporting§ 134.807. State Specific Requirements§ 134.808. Insurance Carrier Edi Compliance Coordinator and Trading Partners
  • Subchapter J. Reviews and Audits
  • § 134.900. Medical Benefit Review and Audit
  • Chapter 136. Benefits—Vocational Rehabilitation

    § 136.1. Review of Employer Report of Injury

    Chapter 149. Memorandum of Understanding with the State Office of Administrative Hearings


    Chapter 156. Representation of Parties Before the Agency—Carrier's Austin Representative

    § 156.1. Carrier's Austin Representative