Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 25 - Hospital Reimbursement Schedule, Billing Instruction and Maintenance Procedures
Section I-2523 - Required Information for Billing Inpatient Services
Universal Citation: LA Admin Code I-2523
Current through Register Vol. 50, No. 9, September 20, 2024
A. Itemization
1. Billing for hospital and other
institutional type services must be submitted on a UB-92 Form as developed and
implemented by the National Uniform Billing (UB-92) Committee. A copy of this
form is on the last page of this Section.
2. Please itemize inpatient charges with the
applicable UB-92 revenue codes. The use of all inclusive accommodation and
ancillary revenue codes is not acceptable. These codes may contain services
which are noncovered.
3. Invalid
revenue codes which are not assigned or defined in the UB-92 manual are not
allowed.
4. Sample UB-92 Form
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:121034.2.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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