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Central Health

Travis County Hospital District

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Search MAP & MAP Basic Provider Handbook by Keyword

Copayments, Groups and Plans

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Last Updated On
byMike McKinnon, Director of Content
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MAP and MAP Basic Only Copays

Group ID MAP 000 53210000 MAP 100 53210000 MAP Basic 000 53230000 MAP Basic 100 53230000 MAP Basic 150 53230000 MAP Basic 175 53230000 MAP Basic 200 53230000 MAP Basic Dental Only 53220000
Physician Services (MD/DO/APP)
Allergy/Asthma Specialist $0 $10 $0 $15 $25 $45 $55 Not Covered
Bridge Program Visits (service provided by Central Health) $0 $10 $0 $10 $15 $25 $30 Not Covered
Cardiology $0 $10 $0 $15 $25 $45 $55 Not Covered
Dermatology $0 $10 $0 $15 $25 $45 $55 Not Covered
Ear, Nose, and Throat (ENT) Specialist $0 $10 $0 $15 $25 $45 $55 Not Covered
Endocrinology $0 $10 $0 $15 $25 $45 $55 Not Covered
Gastroenterology $0 $10 $0 $15 $25 $45 $55 Not Covered
Gynecology Office Visit (routine/preventative primary care-based services) $0 $10 $0 $10 $15 $25 $30 Not Covered
Gynecology (Complex gynecology/UTHA) $0 $10 $0 $15 $25 $45 $55 Not Covered
Hepatology $0 $10 $0 $15 $25 $45 $55 Not Covered
Infectious Disease $0 $10 $0 $15 $25 $45 $55 Not Covered
Musculoskeletal (MSK)/Orthopedics $0 $10 $0 $15 $25 $45 $55 Not Covered
Nephrology $0 $10 $0 $15 $25 $45 $55 Not Covered
Neurology/Neurosurgery $0 $10 $0 $15 $25 $45 $55 Not Covered
Ophthalmology $0 $10 $0 $15 $25 $45 $55 Not Covered
Oral Surgery $0 $10 $0 $15 $25 $45 $55 Same as MAP Basic
Palliative Care $0 $10 $0 $15 $25 $45 $55 Not Covered
Plastics $0 $10 $0 $15 $25 $45 $55 Not Covered
Podiatry $0 $10 $0 $15 $25 $45 $55 Not Covered
Primary Care Provider (PCP) $0 $10 $0 $10 $15 $25 $30 Not Covered
Psychiatry Visit $0 $10 $0 $15 $25 $45 $55 Not Covered
Pulmonology $0 $10 $0 $15 $25 $45 $55 Not Covered
Radiation Therapy (Oncology) (Copay applies to 1st visit of each episode of treatment) $0 $10 $0 $15 $25 $45 $55 Not Covered
Rheumatology $0 $10 $0 $15 $25 $45 $55 Not Covered
Surgical/Medical Optimization $0 $10 $0 $10 $15 $25 $30 Not Covered
Surgical Readiness (Preoperative Clearance) $0 $10 $0 $10 $15 $25 $30 Not Covered
Urology (including vasectomies) $0 $10 $0 $15 $25 $45 $55 Not Covered
Urgent Care $0 $10 $0 $10 $15 $25 $30 Not Covered
Diagnostic X-Rays and Laboratory
Audiology Exam $0 $0 $0 $0 $0 $0 $0 Not Covered
Imaging, Advanced Imaging, and other diagnostics (ex. x-ray, ultrasound, CT, MRI) $0 $0 $0 $0 $0 $0 $0 $0 - Only dental-related imaging covered
Lab $0 $0 $0 $0 $0 $0 $0 $0 - Only dental-related imaging covered
Mammogram $0 $0 $0 $0 $0 $0 $0 Not Covered
Sleep Studies $0 $0 $0 $0 $0 $0 $0 Not Covered
Dental Services
Primary Care Dental $0 $10 $0 $10 $15 $25 $30 Same as MAP Basic
Dentures $0 $35 per arch $0 $35 per arch $35 per arch $35 per arch $35 per arch $35 per arch
Periodontal Visit $0 $10 $0 $10 $15 $25 $30 Same as MAP Basic
Emergency Care
Emergency Room Visit $0 $25 Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Not Covered
Home Health Services, Medical Equipment, and Medical Supplies
Care at Home (service provided by Central Health) $0 $0 $0 $0 $0 $0 $0 Not Covered
Durable Medical Equipment $0 $0 $0 $0 $0 $0 $0 Not Covered
Home Health Visit $0 $0 $0 $0 $0 $0 $0 Not Covered
Medical Supplies $0 $0 $0 $0 $0 $0 $0 Not Covered
Hospital In-Patient Services
Hospitalization/In-patient $0 $30 Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Services are subject to each provider's financial assistance or charity care policy. Not Covered
Outpatient Services
Ambulatory Surgery Center (copay collected by ASC) *No professional copay collected for surgery center services $0 $10 $0 $15 $25 $45 $55 Not Covered
Occupational Therapy (Copay applies to 1st visit of each episode of treatment) $0 $10 $0 $15 $25 $45 $55 Not Covered
Physical Therapy (Copay applies to 1st visit of each episode of treatment) $0 $10 $0 $15 $25 $45 $55 Not Covered
Speech Therapy (Copay applies to 1st visit of each episode of treatment) $0 $10 $0 $15 $25 $45 $55 Not Covered
Transportation Services
non-emergent transport services, including between Seton facilities $0 $0 $0 $0 $0 $0 $0 $0
Other Services
Anethesia $0 $0 $0 $0 $0 $0 $0 $0
Behavioral Health/Social Work Visit/Counseling $0 $0 $0 $0 $0 $0 $0 Not Covered
Case Management services $0 $0 $0 $0 $0 $0 $0 Not Covered
Clinical Pharmacist Visit $0 $0 $0 $0 $0 $0 $0 Not Covered
Community Health Worker (CHW) Visit $0 $0 $0 $0 $0 $0 $0 Not Covered
Dialysis (Patient must have Dialysis Rider on their plan) $0 $0 $0 $0 $0 $0 $0 Not Covered
Dietitian or Nutritionist Visit $0 $0 $0 $0 $0 $0 $0 Not Covered
Hospice $0 $0 $0 $0 $0 $0 $0 Not Covered
Respite/Residential Rooming $0 $0 $0 $0 $0 $0 $0 Not Covered
Skilled Nursing Facilities $0 $0 $0 $0 $0 $0 $0 Not Covered
Substance Use Treatment/ Medication Assisted Therapy (MAT)/Methadone $0 $0 $0 $0 $0 $0 $0 Not Covered
Transitions of Care (service provided at Central Health) $0 $0 $0 $0 $0 $0 $0 Not Covered
Wound Care (provided by nurse) $0 $0 $0 $0 $0 $0 $0 Not Covered
Pharmacy
Pharmacy-Formulary (0-30 day supply) $0 $7 $0 $7 $8 $9 $10 Same as MAP Basic (Only prescriptions prescribed by dentist are covered)
Pharmacy-Formulary (31-90 day supply) $0 $14 $0 $14 $14 $18 $20 Same as MAP Basic (Only prescriptions prescribed by dentist are covered)
Pharmacy-Non-Formulary (0-30 day supply) $0 $10 $0 $10 $10 $14 $15 Same as MAP Basic (Only prescriptions prescribed by dentist are covered)
Pharmacy-Non-Formulary (31-90 day supply) $0 $20 $0 $20 $20 $28 $30 Same as MAP Basic (Only prescriptions prescribed by dentist are covered)
Notice: The Travis County Healthcare District d/b/a Central Health adopted a tax rate that will raise more taxes for maintenance and operations than last year’s tax rate. The tax rate will effectively be raised by 8 percent and will raise taxes for maintenance and operations on a $100,000 home by approximately $8.41(eight dollars and forty one cents).

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