Reimbursement for Sexual Assault Exams

Reimbursement for Sexual Assault Examinations

Law enforcement agencies can apply for reimbursement of sexual assault exams pursuant to article 56.06(a), Texas Code of Criminal Procedure.

The Crime Victims' Compensation Program will reimburse "reasonable costs" associated with forensic sexual assault examinations of victims of alleged sexual assaults in an amount not to exceed $700.00 in the aggregate. CVC has determined that expenses that comply with the Texas Workers' Compensation Commission medical fee guidelines (guidelines), identified as Current Procedural Terminology (CPT) codes, are considered "reasonable expenses." Therefore, you should require your medical providers (physicians) to submit their bills on a Health Care Financing Administration form (HCFA-1500), which is the national standardized health insurance claim form used by physicians.

Sexual assault examiners and Sexual Assault Nurse Examiners (SANE) may submit their bills to you on their standard billing form with a descriptive itemized statement. Certified healthcare facilities, (such as hospitals) that are accredited by the Joint Commission Accreditation of Health Organizations (JCAHO) or Medicare, and that are licensed by the Texas Department of State health Services, must submit their bills to you on a Uniform Billing form (UB-92).

In order to be considered for reimbursement, each cost associated with the medical services or procedures in a sexual assault exam must be itemized and, for services provided by a physician, must be identified with a five-digit Current Procedural Terminology (CPT) code. The CPT code is a nationally accepted systematic listing which is published by the American Medical Association. CPT coding provides an accurate identification of services and procedures.

Bills submitted with the descriptive itemization of a sexual assault examination without further information or services listed and without individual charges listed for each service will receive reimbursement only for the sexual assault exam and not for any additional medical services.

If under the medical fee guidelines there are no specific CPT codes for the medical services or procedures provided in the sexual assault exam, CVC will accept a Revenue Code, or the CPT code for services or procedures that are comparable to those used in the sexual assault exam. For example:

The following are guidelines to provide further assistance in completing the application:

  1. Complete all sections of the one-page application for reimbursement. The verification section of the application must be signed by an appropriate representative of the law enforcement agency who has knowledge of the facts stated in the verification.
  2. Attach all bills associated with the requested sexual assault exam to the application. Expenses other than the actual costs for the sexual assault exam, such as treatment or diagnosis of a victim, are not allowable expenses and will not be reimbursed under this program, but may be compensable under a regular CVC claim. Below is a standard list of costs associated with a sexual assault:

The law enforcement agency must complete all sections of the OAG approved Application for Reimbursement. Incomplete applications will not be processed and will be returned to the law enforcement agency noting the reason the application is incomplete. All bills associated with the requested forensic sexual assault examination must be attached to the application, and only those expenses for the actual forensic sexual assault examination will be considered for reimbursement. All bills must be submitted at one time. No other bills submitted to the OAG will be processed after the Application for Reimbursement is received. A completed application is one that:

Reimbursement for Costs of Sexual Assault Medical Examinations
Form 06-019 (PDF)
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