Itemized Billing
What is Itemized Billing?
Itemized billing is the listing of individual charges incurred for a health care service. Specifically, an itemized bill must include three things:
- A plain language description of each distinct health care service or supply the health care provider provided to the patient.
- If the provider sought or is seeking reimbursement from a third party, any billing code submitted to the third party and the amounts billed to and paid by that third party.
- The amount the provider alleges is due from the patient for each service and supply provided to the patient.
If the billing codes a provider submits to a third party for reimbursement are codes for bundled services, then a provider must include all bundle codes and the amounts billed for each bundle code in the itemized bill.
A provider is not required to provide an itemized bill to collect payment from a patient before a service or good is delivered such as a co-payment or co-insurance payment.
A provider may issue the itemized bill electronically, including through a patient portal on the provider's website. Providers must take measures to protect a patient’s personal health information in accordance with state and federal law.
Further information is available in Texas Health and Human Services Health Facility Guidance Letter GL 23-2002 (PDF).
Who is Required to Provide an Itemized Bill?
A facility licensed, certified, or otherwise authorized to provide health care services or supplies in this state in the ordinary course of business including a hospital. The term includes Orthotic and Prosthetic facilities licensed by TDLR.
The term does not include a federally-qualified health center, as defined by 42 U.S.C. § 1396d(l)(2)(B)
Why Is This Now a Rule?
The Texas Legislature passed Senate Bill 490 in the 88th Regular Session. The legislature is responding to calls for clarity by Texans with regard to medical billing.
Exemptions
All TDLR licensed Orthotics and Prosthetic facilities must comply with the new law. Federally Qualified Health Centers (FQHC) are exempt from this rule.
