RULE

Jurisdiction
Louisiana
Publication
Issue 10
Volume 46
Published October 20, 2020
Rule Type
Final Rule
Issuing Body
Workforce Commision
Office of Workers' Compensation Administration

Notice Text

RULE Workforce Commission Office of Workers' Compensation Administration Medical Treatment Guidelines (LAC 40:I.5125 and 5157) The Louisiana Workforce Commission has amended certain portions of the Medical Guidelines contained in the Louisiana Administrative Code, Title 40, Labor and Employment, Part I, Workers' Compensation Administration, Subpart 2, Medical Guidelines, Chapter 51, §§5125 and 5157 regarding medical reimbursement. The amendments add applicable billing codes that are pandemic related. It allows providers to use telemedicine/telehealth methods and deliver care that was established in response to COVID-19. This Rule is promulgated by the authority vested in the director of the Office of Workers' Compensation Administration found in R.S. 23:1291 and R.S. 23:1310.1(C). This Rule is hereby adopted upon promulgation.
Title 40 LABOR AND EMPLOYMENT Part I. Workers' Compensation Administration Subpart 2. Medical Guidelines Chapter 51. Medical Reimbursement Schedule 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. §5125. Special Instructions A. Procedure Codes Not Listed in Rules 1. - 3. … B. Modifiers 1. Modifier codes must be used by providers to identify procedures or services that are modified due to specific circumstances. 2. Modifiers listed in the CPT must be added to the procedure code when the service or procedure has been altered from the basic procedure described by the descriptor. 3. When Modifier-22 is used to report an unusual service, a report explaining the medical necessity of the situation must be submitted with the claim to the carrier. It is not appropriate to use Modifier-22 for routine billing. 4. The use of modifiers does not imply or guarantee that a provider will receive reimbursement as billed. Reimbursement for modified services or procedures must be based on documentation of medical necessity and must be determined on a case by case basis. 5. The modifier 95 appended to a code indicates it was performed by telemedicine/telehealth methods. Services should be reimbursed the same amount as the exact same codes without the modifier as long as the Emergency Rule exist. If carrier requires a Place of Service (POS) code for telemedicine/telehealth, code 02 may be used. C. - F. 2. … AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2. HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation Administration, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994), amended by the Louisiana Workforce Commission, Office of Workers' Compensation Administration, LR 46:1400 (October 2020). §5157. Maximum Reimbursement Allowances A. Table 1 * * * B. Table 2 Cpt CodeModDescriptionGlobalDaysMaximumAllowanceNon-FacilityMaximumFacilityMaximum * * * 86328 IA Infectious Agt Antibody SARS-COV-2 COVID-19 $90 * * * 86769 Antb Severe Aqt Respir Synd SARS-COV-2 COVID19 $84 * * * 87635 IADNA SARS-COV-2 COVID-19 Amplified Probe TQ $103 * * * 90791 Psychiatric Diagnostic Evaluation BR 90792 Psychiatric Diagnostic Eval W/Medical Services BR * * * 90832 Psychotherapy W/Patient 30 Minutes BR 90833 Psychotherapy W/Patient W/E&M Srvcs 30 Min BR 90834 Psychotherapy W/Patient 45 Minutes BR 90836 Psychotherapy W/Patient W/E&M Srvcs 45 Min BR 90837 Psychotherapy W/Patient 60 Minutes BR 90838 Psychotherapy W/Patient W/E&M Srvcs 60 Min BR * * * 90863 Pharmacologic Management W/Psychotherapy BR * * * 92521 Evaluation Of Speech Fluency (Stutter Clutter) BR 92522 Evaluation Of Speech Sound Production Articulate BR 92523 Eval Speech Sound Product Language Comprehension BR 92524 Behavioral & Qualit Analysis Voice And Resonance BR * * * 96105 Assessment Aphasia W/Interp & Report Per Hour BR * * * 96156 Health Behavior Assessment/Re-Assessment BR 96158 Health Behavior Ivntj Indiv F2f 1st 30 Min BR 96159 Health Behavior Ivntj Indiv F2f Ea Addl 15 Min BR * * * 97129 Ther IVNTJ Cog Funcj CNTCT 1ST 15 Minutes BR 97130 Ther IVNTJ Cog Funcj CNTCT EA Addl 15 Minutes BR * * * 97161 Physical Therapy Evaluation Low Complex 20 Mins BR 97162 Physical Therapy Evaluation Mod Complex 30 Mins BR 97163 Physical Therapy Evaluation High Complex 45 Mins BR 97164 Physical Therapy Re-Eval Est Plan Care 20 Mins BR 97165 Occupational Therapy Eval Low Complex 30 Mins BR 97166 Occupational Therapy Eval Mod Complex 45 Mins BR 97167 Occupational Therapy Eval High Complex 60 Mins BR 97168 Occupational Ther Re-Eval Est Plan Care 30 Mins BR * * * 98970 QNHP Ol Digital ASSMT&MGMT Est Pt <7 D 5-10 Min $25 98971 QNHP OL Digital Assmt and Mgmt Est PT <7 D 11-20 MIN $65 98972 QNHP OL Digital Assmt and Mgmt Est PT <7 D 21+ MIN $150 * * * 99421 Online Digital E/M SVC Est Pt <7 D 5-10 Minutes $31 $27 99422 Online Digital E/M SVC Est Pt <7 D 11-20 Minutes $62 $55 99423 Online Digital E/M SVC Est Pt <7 D 21+ Minutes $100 $87 * * * 99495 Transitional Care Manage Srvc 14 Day Discharge BR 99496 Transitional Care Manage Srvc 7 Day Discharge BR * * * C. Table 3
Code Mod Description GlobalDays MaximumAllowance Non-FacilityMaximum FacilityMaximum
C9803 COVID-19 Specimen Collection HOPD BR
G2010 Remot Image Submit By PT $24
G2012 Brief Check In By MD/QHP $27
G2023 Specimen Collect COVID-19 $47
G2024 Spec Coll SNF/Lab COVID-19 $51
G2061 Qual NonMD Est PT 5-10M $25
G2062 Qual NonMD Est PT 11-20M $43
G2063 Qual NonMD Est PT 21>Min $68
U0001 2019-NCOV Diagnostic P $72
U0002 COVID-19 Lab Test Non-CDC $103
U0003 SARS-COV-2 COVID-19 Amp Prb Htt $200
U0004 COVID-19 Lab Test Non-CDC Htt $200
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2. HISTORICAL NOTE: Promulgated by the Department of Labor, Office of Workers' Compensation Administration, 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 Administration, LR 39:1854 (July 2013), LR 40:379 (February 2014), amended by the Workforce Commission, Office of Workers' Compensation Administration, LR 42:1696 (October 2016), LR 46:1401 (October 2020). Ava Dejoie Secretary 2010#032