The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise:
(1) CDT--Current Dental Terminology code set maintained by the American Dental Association.
(2) CPT--Current Procedural Terminology code set maintained by the American Medical Association.
(3) Department or TDI--Texas Department of Insurance.
(4) Form--In Division 2 of this subchapter, the Texas Standard Prior Authorization Request Form for Health Care Services. In Division 3 of this subchapter, the Texas Standard Prior Authorization Request Form for Prescription Drug Benefits.
(5) HCPCS--Healthcare Common Procedure Coding System.
(6) Health benefit plan--
(7) Health benefit plan issuer--An entity authorized under the Insurance Code or another insurance law of this state that delivers or issues for delivery a health benefit plan or other coverage described in Insurance Code §1217.002 or Insurance Code §1369.252.
(8) Health care service--A service to diagnose, prevent, alleviate, cure, or heal a human illness or injury that is provided by a physician or other health care provider. The term includes medical or health care treatments, consultations, procedures, drugs, supplies, imaging and diagnostic services, inpatient and outpatient care, medical devices other than those included in the definition of prescription drugs in Occupations Code §551.003, and durable medical equipment. The term does not include prescription drugs or devices as defined by Occupations Code §551.003.
(9) ICD--International Classification of Diseases.
(10) Issuer--A health benefit plan issuer and the agent of a health benefit plan issuer that manages or administers the issuer's health care services or prescription drug benefits.
(11) NDC--National Drug Code.
(12) NPI number--A provider's or facility's National Provider Identifier.
(13) Prescription drug--Has the meaning assigned by Occupations Code §551.003.
Source Note: The provisions of this §19.1803 adopted to be effective September 1, 2015, 39 TexReg 9699; amended to be effective September 1, 2015, 40 TexReg 2193; amended to be effective August 11, 2022, 47 TexReg 4681