La. Admin. Code tit. 40 § I-5133

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

Section I-5133 - Injections

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 to the procedure codes for the second and subsequent drugs.

3. Reimbursement for multiple drugs administered from the same syringe must be at the provider's usual charge or the maximum reimbursement allowable, whichever is less for the first drug, and the provider's charge or 50 percent of the maximum reimbursement allowable, whichever is less for each additional drug.

4. Reimbursement for injections includes the cost of the drug, the charge for the administration of the drug and the cost of the supplies used to administer the drug.

5. Reimbursement for anesthetic agents, such as Xylocaine and Carbocaine, when used for infiltration, is included in the reimbursement for the basic procedure performed and must not be separately reimbursed.

B. Intra-Articular or Intrabursal Injections

1. CPT Procedure Codes 20550-20615 must be billed for intra-articular or intrabursal injections.

2. Reimbursement for these injection codes includes the supplies usually required to perform the procedure, but not the medications.

3. An invoice documenting the cost of the injectable medications must be submitted with the claim form since reimbursement is limited to the provider's charge or up to 20 percent above the actual cost to the provider, whichever is less.

La. Admin. Code tit. 40, § I-5133

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.