La. Admin. Code tit. 40 § I-4511

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-4511 - Noncovered Services

A. Only those services specifically listed in the section of this manual entitled "Maximum Reimbursement Allowances" are covered. Charges billed under the code for unlisted services or equipment will be reviewed prior to any pricing. Charges for items under this code that were not pre-authorized will be disallowed. Noncovered professional services include but are not limited to:

1. any service considered investigational or experimental, such as membrane diffusion capacity;

2. services not ordered by a physician or administered under the direction of a physician or by qualified medical staff; and

3. services not consistent with the patient's diagnosis, treatment or respiratory problems.

B. No charge will be allowed for deliveries of equipment unless the point of delivery is more than 50 miles from the provider's place of business.

La. Admin. Code tit. 40, § I-4511

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.