La. Admin. Code tit. 40 § I-2511
Current through Register Vol. 50, No. 9, September 20, 2024
Section I-2511 - Rehabilitation Services ReimbursementA. Inpatient. Reimbursement for inpatient rehabilitation facility services will be limited to the lesser of covered billed charges or the per diem amount. 1. The uniform statewide per diem rate will be applied to inpatient days by type of facility, either hospital based or freestanding.2. The reimbursement amount will be reduced by charges for noncovered items and services. Per Diem Rate Schedule |
Hospital Based Rehabilitation Facility | $ 704 |
Freestanding Rehabilitation Facility | $1225 |
3. Using the above per diems, the formula for calculating payment amount is the same as that for inpatient hospital services found in §2505. B.1B. Outpatient. Rehabilitation services rendered on an outpatient basis by professional providers such as medical doctors, physical therapists, occupational therapists, and speech therapists will be reimbursed based on the customary and reasonable fee schedule for related CPT-4 procedure codes promulgated by the state of Louisiana, Office of Workers' Compensation. Any facility fees associated with delivery of these professional services will be reimbursed at covered charges less a 10 percent discount. The formula for calculating payment is: (Billed Charges) - (Noncovered Charges) = Covered Charges x 0.90 = Payment Amount
La. Admin. Code tit. 40, § I-2511
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).AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.