Sec. 413.017. PRESUMPTION OF REASONABLENESS. The following medical services are presumed reasonable:
(1) medical services consistent with the medical policies and fee guidelines adopted by the commissioner; and
(2) medical services that are provided subject to prospective, concurrent, or retrospective review as required by the medical policies of the division and that are authorized by an insurance carrier.
Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993.
Amended by:
Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 3.240, eff. September 1, 2005.
Structure Texas Statutes
Title 5 - Workers' Compensation
Subtitle A - Texas Workers' Compensation Act
Subchapter B. Medical Services and Fees
Section 413.011. Reimbursement Policies and Guidelines; Treatment Guidelines and Protocols
Section 413.0111. Processing Agents
Section 413.0112. Reimbursement of Federal Military Treatment Facility
Section 413.0115. Requirements for Certain Voluntary or Informal Networks
Section 413.012. Medical Policy and Guideline Updates Required
Section 413.014. Preauthorization Requirements; Concurrent Review and Certification of Health Care
Section 413.0141. Initial Pharmaceutical Coverage
Section 413.015. Payment by Insurance Carriers; Audit and Review
Section 413.016. Payments in Violation of Medical Policies and Fee Guidelines
Section 413.017. Presumption of Reasonableness
Section 413.018. Review of Medical Care if Guidelines Exceeded
Section 413.019. Interest Earned for Delayed Payment, Refund, or Overpayment
Section 413.020. Division Charges
Section 413.021. Return-to-Work Coordination Services
Section 413.022. Return-to-Work Reimbursement Program for Employers; Fund
Section 413.023. Information to Employers