Louisiana Administrative Code

A. The carrier/self-insured employer is responsible for 100 percent of the maximum allowable reimbursement rate for covered services rendered for treatment of compensable conditions. The claimant is not required to contribute a co-payment and does not have to meet any deductibles…

A. Whenever a claimant is eligible for Medicare or payment from another third party payer and is also eligible for workers' compensation medical benefits, the carrier/self-insured employer is always the primary payer, the payer of first resort. Services related to compensable con…

A. The Louisiana Workers' Compensation Statutes (R.S. 23:1142) establishes a monetary limit for nonemergency medical care. The statute further provides significant penalties for a carrier/self-insured employer's arbitrary and capricious refusal to approve necessary care beyond th…

A. The HCFA 1500 Form is to be used by health care providers except dentist, pharmacy, hospital (unless otherwise stated), and for home and vehicle modifications for billing services provided to workers' compensation claimant. Do not use any other form. A sample HCFA 1500 Claim F…

A. Diagnosis Coding. The International Classification of Diseases, Tenth Revision (ICD-10-CM) is the basis of diagnosis coding. These are the disease codes in the international classification, tenth revision, clinical modifications published by the U.S. Department of Health and H…

A. General Guidelines 1. Global Surgery. The reimbursement allowances for surgical procedures are based on a global reimbursement concept that covers performing the basic service and the normal range of care required before and after surgery. The global reimbursement includes: a.…

A. General. The total anesthesia allowance is calculated by adding the basic value units, time value units, plus any applicable modifier unit values and/or unusual qualifying circumstances units and multiplying the sum by a dollar amount allowed per unit. 1. Basic Units. A basic …

A. Any health care provider who gives deposition shall be allowed a witness fee. Procedure Code 99075 must be used to bill for a deposition. Reimbursement for a deposition should be a specific amount mutually agreed upon and in writing, in advance of the event. Fees may be at an …

A. The provider shall not receive payment for a missed appointment unless the appointment was arranged by the carrier or the employer. If the carrier or employer fails to cancel the appointment not less than 72 hours prior to the time of the appointment and the provider is unable…

A. Health care providers must submit copies of records and reports to carriers, employers, claimants or their attorney and the Office of Workers' Compensation Administration upon request. Providers can facilitate the timely processing of claims and payment for services by submitt…

A. Procedure Codes Not Listed in Rules 1. If a procedure is performed which is not listed in the maximum reimbursement allowance, the health care provider must use an appropriate CPT code descriptor. The provider must submit a narrative report to the carrier to explain why it was…

A. Practicing Physical and Occupational Therapists 1. To bill for physical therapist and/or occupational therapist services under workers' compensation, a practicing therapist must be: a. currently licensed in the state of Louisiana as a physical therapist or as an occupational t…

A. Procedure Codes 95004-95199 must be billed for allergy testing and allergy immunotherapy. B. When billing for allergy tests, enter the appropriate CPT procedure code in Item 24-D of the HCFA 1500 Form. 1. Enter the total number of tests performed in Item 24-G. 2. Enter the tot…

A. Biofeedback training may be reimbursed when it is medically necessary. A written plan of care which includes objectives, the estimated length of treatment and stated goals must be submitted to the carrier/self-insured employer for approval prior to the services being provided.…

A. Subcutaneous, Intramuscular and Intravenous 1. Procedure Codes 90700-90749 are reimbursed by report only. The report must include the name of the medication strength and volume injected. 2. When multiple drugs are administered from the same syringe, Modifier-51 must be added t…

A. Examination, evaluations, treatments, conferences with or concerning patients, and similar medical services necessitate wide variations in the skill, effort, time, responsibility and medical knowledge required for the diagnosis and treatment of work-related illnesses and on th…

A. General 1. Neurologic services are typically consultation services and any of the levels of consultation (Procedure Codes 99241-99263) may be appropriate. However, when one is the attending physician for or partial care, the appropriate evaluation and management level of servi…

A. General 1. Psychiatric evaluations may be provided as independent medical examinations (IMEs) when requested by the carrier/self-insured employer. 2. Psychiatric evaluations may be provided as consultations when requested by a physician and when authorized by the carrier/self-…

A. Initial Visits 1. Initial (new patient) treatment for soft tissue injuries must be billed under the appropriate medical (office) visit code. 2. When a cast or strapping is applied during initial visit, supplies and materials used such as stockinette, plaster, fiberglass, ace b…

A. General Information 1. When medically necessary, thermographic testing may be used as an assistive device in the diagnosis of many different conditions. 2. When a request for authorization for thermography is received, carriers must ensure that a specially trained, qualified p…

A. Medical Consultant. Carriers must utilize the expertise of physicians or other health care professionals in making determinations pertaining to acceptable, safe medical care and treatment and appropriate reimbursement for services rendered. The consultants should have expertis…

A. Carriers must provide an explanation of medical benefits (EOMB) to health care providers whenever the carrier's reimbursement differs from the amount billed by the provider. The EOMB must be provided with the reimbursement check. 1. A carrier must use the listed EOMB codes and…

A. When, after examination of the EOMB, a health care provider is dissatisfied with a carrier's payment of a bill for medical services, a reconsideration may be requested by the provider. 1. A provider must make a written request for reconsideration within 60 days from receipt of…

A. A patient may receive medical services in Louisiana for injuries incurred in an out-of-state accident. 1. If the patient is receiving treatment under the Workers' Compensation Law of another state, this manual may not apply. 2. If the patient is receiving care and treatment in…

A.1. Each employer shall furnish all necessary drugs, supplies, hospital care and services, medical and surgical treatment, and any nonmedical treatment recognized by the laws of this state as legal. All such care, services, and treatment shall be performed at facilities within t…

A. Maintenance of the schedules requires that a database of applicable charges be accumulated by the carrier/self-insured employer. This database will be utilized to profile the charges by each appropriate code. B. Information Required. In order to update the schedule, each carri…

A. Table 1 Maximum Fee Allowance Schedule Office of Workers' Compensation CPT Code Mod Description Global Days Maximum Allowance 00100 Anesthesia for procedures on salivary glands, including biopsy 5 + TM 00102 Plastic repair of cleft lip 6 + TM 00103 Blepharoplasty 5 + TM 00104 …

A. The authorized representative(s) of the department shall schedule the initial on-site inspection with the applicant laboratory. The authorized representative(s) of the department may make an announced or unannounced inspection or examination of an accredited laboratory wheneve…

A. The laboratory conditions in which the tests are undertaken shall not invalidate the test results or adversely affect the required accuracy of measurement. The laboratory shall have the equipment, adequate storage facilities, procedures to preserve the identity, concentration …

A. The testing laboratory shall have adequately documented instructions on the use and operation of all relevant equipment, on the handling and preparation of test items, where applicable, and on standard testing techniques, where the absence of such instructions could jeopardize…

A. Whenever deviations or deficiencies are found during an inspection, documentation of same will be included in the written report as required in LAC 33:I.5101.E.7. The laboratory representatives (or designees) will be asked to attest to (sign) receipt of the on-site inspection …

A. The department shall prepare for each accredited laboratory a listing of the test categories for which the laboratory has demonstrated proficiency during inspections. Inspection reports and listings shall be deemed public records. The department shall prepare a certificate of …

A. While specific safety criteria are not an aspect of laboratory accreditation, laboratory personnel should apply general and customary safety practices as part of good laboratory procedures. Each laboratory is strongly encouraged to have a written safety plan as part of their s…

A. Each person who conducts coal exploration or development which substantially disturbs the natural land surface and in which 250 tons or less of coal are removed shall apply for a permit required under §§2101 and 2109 and shall comply with

A. Each person who conducts coal exploration or development which substantially disturbs the natural land surface and which removes more than 250 tons of coal shall, while in the exploration or development area, possess written approval of the office for the activities granted un…

A. The performance standards in this Section are applicable to coal exploration or development which substantially disturbs the land surface. 1. Habitats of unique or unusually high value for fish, wildlife and other related environmental values and critical habitats of threatene…

A. Except as provided under §5107.B, any person who intends to commercially use or sell coal extracted during coal exploration operations under an exploration permit shall first obtain a permit to conduct surface coal mining operations for those operations from the office under C…

A. Under R.S. 39:1561 the Commissioner is granted broad authority and responsibility to consider and decide matters of policy under the Procurement Code. Pursuant to R.S. 39:1556(42) the chief procurement officer for the state of Louisiana may add to the enumerated occupations or…

A. To respond to the needs of state agencies, it shall be the policy of the Office of State Procurement to regularly review and to supplement the professions, occupations and services covered under R.S. 39:1556 (Professional Services) and R.S. 39:1619 (Social Services) in order t…

A. Professional Services. An agency head may present a request to the state chief procurement officer to classify an independent contractor who has a professed knowledge of a department of learning or science used by its practical application to the affairs of others or in the pr…

A. Once added, nothing in this policy or in these procedures shall prevent the Office of State Procurement from removing a professional or social service from the Tables Appendix if it is deemed in the best interests of the state to do so. Once removed, a professional or social s…

A. Professional Services Table of Professional Services The following services shall supplement those listed in R.S. 39:1556(42). Service Effective Date Licensed chiropractors January 1, 2017 B. Social Services Table of Social Services The following services shall supplement thos…

A. Regulation 66 is promulgated pursuant to the authority vested in the commissioner under the Louisiana Insurance Code, R.S. 22:1 et seq.

A. The purpose of Regulation 66 is to require that officers, directors and trustees of domestic regulated entities, as herein defined, file biographical and other applicable, relevant, and appropriate information with the commissioner for review and approval. The purpose of this …

A. Regulation 66, as amended, shall apply to all individuals serving as an officer, director, or trustee of a domestic regulated entity and to all individuals nominated or otherwise suggested for such positions.

A. For the purpose of Regulation 66, the following definitions shall be applicable. Director⎯person(s) designated in the articles of incorporation, by-laws, or other organizational documents as such, and person(s) designated, elected, or appointed by any other name or title to ac…

A. No person shall serve as an officer, director, or trustee of a domestic regulated entity who has not first submitted the information required by §5111 to the commissioner or to whom, after review of the information required by §5111, the commissioner has refused to issue a let…