Louisiana Administrative Code
Title 37 - INSURANCE
Part XIII - Regulations
Chapter 23 - Regulation 48-Standardized Claims Forms
Section XIII-2303 - Definitions

Current through Register Vol. 50, No. 3, March 20, 2024

CDT-1 Codes- the current dental terminology prescribed by the American Dental Association.

CPT-4 Codes- the current procedural terminology published by the American Medical Association.

HCFA- the Federal Health Care Financing Administration of the U.S. Department of Health and Human Services.

HCFA for UB92- the health insurance claim form published by HCFA for use by institutional care providers.

HCFA Form 1500- the health insurance claim form published by HCFA for use by health care providers.

HCPCS- HCFA's common procedure coding system which is based upon the AMA's Physician Current Procedural Terminology, Fourth Edition (CPT-4).

1.HCPCS Level I Codes- the AMA's CPT-4 codes with the exception of anesthesiology services.

2.HCPCS Level 2 Codes- the codes for physician and nonphysician services are not included in COT-4.

Health Care Provider-

1. an acupuncturist licensed under R.S. 37:1356-1360;

2. a certified registered nurse anesthetist licensed under R.S. 37:930;

3. a chiropractor licensed under R.S. 37:2801-2830.7;

4. a dentist licensed under R.S. 37:751-794;

5. a dietician and nutritionist licensed under R.S. 37:3081-3093 and 36:259U;

6. durable medical equipment suppliers;

7. an emergency medical technician licensed under R.S. 40:1231-1232;

8. a general health clinic (excluding early periodic screening diagnosis treatment clinics) certified by the Louisiana Department of Health and Hospitals;

9. a hearing aid dealer licensed under R.S. 37:2441-2465;

10. a licensed practical nurse licensed under R.S. 37:961;

11. a mental health counselor licensed under R.S. 37:1101-1115;

12. a mental health clinic licensed under R.S. 28:567;

13. a midwife licensed under R.S. 37:3240-3257;

14. an occupational therapist licensed under R.S. 37:3001-3014;

15. an optometrist licensed under R.S. 37:1052;

16. a physical therapist and physical therapist assistant licensed under R.S. 37:2401-2419;

17. a physician licensed under R.S. 37:1261-1292;

18. a physician assistant licensed under R.S. 37:1360.21-27;

19. a podiatrist licensed under R.S. 37:611-628;

20. a psychologist licensed under R.S. 37:2351-2370;

21. a registered nurse licensed under R.S. 37:911-931;

22. a rehabilitation center licensed under 42:CFR 405.1701Q;

23. a respiratory therapist licensed under R.S. 37:3351-3361;

24. a social worker licensed under R.S. 37:2701-2718;

25. a speech pathologist and audiologist licensed under R.S. 2651-2665;

26. a substance abuse counselor licensed under R.S. 37:3371-3384;

27. a substance abuse prevention/treatment program licensed under R.S. 40:1058.1-1058.3;

28. a free standing ambulatory surgical center licensed under R.S. 40:2131-2141;

29. any other health care providers as licensed by the state of Louisiana;

ICD-9-CM Codes- the disease codes in the International Classification of Diseases, Ninth Revision, clinical modifications published by the U.S. Department of Health and Human Services.

Institutional Care Provider-

1. an adult day health care provider licensed under R.S. 46:1971-1980;

2. an ambulatory surgical center licensed under R.S. 40:2131-2143;

3. a drug screening laboratory licensed under R.S. 49:1111-1113, 1115-1118, 1121, 1122, and 1125;

4. an end stage renal dialysis facility under 42:CFR 405.2100;

5. a home health agency licensed under R.S. 40:2009.31-2009.40;

6. a hospice licensed under R.S. 40:2181-2191;

7. a hospital licensed under R.S. 40:2100-2114;

8. a nursing home licensed under R.S. 40:2009;

9. a residential care/community group home or residential facility licensed under R.S. 46:51, 1401-1411, and 28:1-284;

10. any other institutional care provider as licensed by the state of Louisiana.

J512 Form- the uniform dental claim form approved by the American Dental Association for use by dentists.

Medicaid- Title XIX of the Federal Social Security Act.

Medicare- Title XVIll of the Federal Social Security Act.

Revenue Codes- the codes established for use by institutional care providers by the National Uniform Billing Committee.

AUTHORITY NOTE: Promulgated in accordance with R.S.22:10, 22:213(A)(14), and 22:3016(C) of the Insurance Code.