Contents october 2013 I. Executive orders
Part I. Workers' Compensation Administration
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- Chapter 41. Durable Medical Equipment and Supplies Reimbursement Schedule, Billing Instructions, and Maintenance Procedures
- State of Louisiana Office of Workers Compensation Schedule of Maximum Allowances for Durable Medical Equipment
- Purchase Used Rental
- Subpart 2. Medical Guidelines
- Office of Workers Compensation Schedule of Maximum Allowances for Prosthetic and Orthopedic Equipment
- Chapter 51. Medical Reimbursement Schedule
- §5101. Statement of Policy
- §5127. Physical Medicine
- §5157. Maximum Reimbursement Allowances
- Maximum Fee Allowance Schedule Office of Workers Compensation CPT Code
- Maximum Allowance Non-Facility Maximum
- Chapter 53. Dental Care Services, Reimbursement Schedule and Billing Instructions
| Part I. Workers' Compensation Administration
Subpart 1. General Administration Chapter 3. Electronic Billing §306. Electronic Medical Billing and Payment Companion Guide A. - J. … * * *
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AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1310.1. HISTORICAL NOTE: Promulgated by the Louisiana Workforce Commission, Office of Workers Compensation Administration, LR 39:331 (February 2013), amended LR 39: §307. Billing Code Sets A. - A.7. … 8. “Physical Therapy”/”Occupational Therapy Codes: Codes specified in Title 40 of the LAC covering physical therapy and occupational therapy services. 9. - 10. …. AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1203.2. HISTORICAL NOTE: Promulgated by the Louisiana Workforce Commission, Office of Workers' Compensation, LR 37:3544 (December 2011), amended LR 39: Chapter 41. Durable Medical Equipment and Supplies Reimbursement Schedule, Billing Instructions, and Maintenance Procedures Editor's Note: Other Sections applying to this Chapter can be found in Chapter 51. §4119. Maximum Allowance Schedules A. Durable Medical Equipment
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2. HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994), amended by the Workforce Commission, Office of Workers’ Compensation, LR 39:1841 (July 2013), LR 39:
Chapter 43. Prosthetic and Orthopedic Equipment §4339. Schedule of Maximum Allowances and Procedural Codes A. - A.3. … B. Prosthetic and Orthopedic Equipment
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2. HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994), amended by the Workforce Commission, Office of Workers’ Compensation, LR 39:1847 (July 2013), LR 39:
Editor's Note: The following Sections of this Chapter are applicable and shall be used for the Chapters in this Part governing reimbursement. These specific Chapters are: Chapter 25, Hospital Reimbursement; Chapter 29, Pharmacy; Chapter 31, Vision Care Services; Chapter 33, Hearing Aid Equipment and Services; Chapter 35, Nursing/Attendant Care and Home Health Services; Chapter 37, Home and Vehicle Modification; Chapter 39, Medical Transportation; Chapter 41, Durable Medical Equipment and Supplies; Chapter 43, Prosthetic and Orthopedic Equipment; Chapter 45, Respiratory Services; Chapter 47, Miscellaneous Claimant Expenses; Chapter 49, Vocational Rehabilitation Consultant; Chapter 51, Medical Reimbursement Schedule; and Chapter 53, Dental Care Services. §5101. Statement of Policy A. - B.3. … 4. Statements of charges shall be made in accordance with standard coding methodology as established by these rules, ICD-9-CM, HCPCS, CPT-4, CDT-1, NDAS coding manuals. Unbundling or fragmenting charges, duplicating or over-itemizing coding, or engaging in any other practice for the purpose of inflating bills or reimbursement is strictly prohibited. Services must be coded and charged in the manner guaranteeing the lowest charge applicable. Knowingly and willfully misrepresenting services provided to workers' compensation claimants is strictly prohibited. 5.- 8. …
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2. HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994), amended by the Workforce Commission, Office of Workers’ Compensation, LR 39: §5127. Physical Medicine A. - A.1.b. … c. services must be billed using the appropriate national CPT codes as listed in this manual. A.2. - B.3.b. ... C. Assessment 1. Billing. The initial, written assessment developed by the therapist must be reported to the carrier using procedure code, 97001 or 97003. 2. Reimbursement a. Only one initial assessment per injury may be reimbursed. Reimbursement for the use of additional initial assessment time is not allowed. b. Reimbursement for reassessment shall be recommended only once in a seven day period. Reassessment for established patients shall be billed under 97002 or 97004. c. Assessment of the patient's status includes assessment of the neuromuscular system. Therefore, reimbursement must not be made for neuromuscular testing codes, extremity testing codes and/or range of motion codes except for those testing procedures identified by the following code: 97535 or 97755. D. - D.1.b.ii. … 2. Reimbursement a. No more than one visit per day for the purpose of therapy may be reimbursed. b. The carrier should compare the billing with the plan of care to ensure that only the services that are itemized in the plan of care are reimbursed. c. Since the Hubbard Tank or Therapeutic Pool is designed for full body immersion, unless full body immersion is medically necessary and prescribed, Procedure Codes 97036 must not be reimbursed. d. Prior written authorization must be obtained when billing for more than eight modalities, procedures or combination in one physical and occupational therapy session. e. Therapeutic exercises and procedures codes 97150, 97110, 97530 are to utilized by physical therapists when billing for therapeutic exercise and procedures such as, but not limited to, joint mobilization, gait training, muscle re-education, activities of daily living, patient education, etc. E. - F. … 1. Evaluation of orthotics shall be billed according to §5127.C. 2. Fabrication and fitting of orthotics shall be billed under 97530 or 97760 as a PT/OT procedure. 3. Supplies shall be billed according to §5127.F. H. Test and Measurements 1. Reimbursement for extremity testing, muscle testing and range of motion measurements shall be billed according to §5127.C. 2. Procedure codes 97755 shall be used when testing is performed by means of mechanical equipment. These procedure codes shall include print out of test results with report. a. Prior authorization is required to bill 97755 if testing exceeds 30 minutes for single joint, single plane; or, 45 minutes for single joint multiple plane; or, 45 minutes for multiple joint, multiple plane for noninvolved side. b. Prior authorization is required to bill 97755 if re-testing exceeds 15 minutes for single joint, single plane; or 30 minutes for single joint multiple plane; or, 30 minutes for multiple joint, multiple plaine for noninvolved side. I. - I.4.e. … * * * AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2. HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994), amended by the Workforce Commission, Office of Workers’ Compensation, LR 39: Maximum_Reimbursement_Allowances'>§5157. Maximum Reimbursement Allowances A. Table 1
B. Table 2
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2. HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994), LR 27:314 (March 2001), amended by the Workforce Commission, Office of Workers’ Compensation, LR 39:1854 (July 2013), LR 39: Chapter 53. Dental Care Services, Reimbursement Schedule and Billing Instructions Editor's Note: Other Sections applying to this Chapter can be found in Chapter 51. Directory: osr -> reg reg -> Contents september 2009 I. Executive order osr -> Table of Contents Title 46 Professional and Occupational Standards osr -> Table of Contents Title 46 Professional and Occupational Standards osr -> Part I. Wildlife and Fisheries Commission and Agencies Thereunder 1 reg -> Contents april 2009 I. Executive order osr -> Chapter Purpose 2 §101. Introduction 2 osr -> Part V. Automotive Industry 1 Subpart Motor Vehicle Commission 1 reg -> Contents december 2010 I. Emergency rules Download 5.02 Mb. Share with your friends:
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