Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 45 - Respiratory Services Reimbursement Schedule, Billing Instructions, and Maintenance Procedures
Section I-4537 - Maximum Reimbursement Allowance

Universal Citation: LA Admin Code I-4537

Current through Register Vol. 50, No. 9, September 20, 2024

A. Maximum allowable reimbursement for compensable professional respiratory therapy services will be based upon the lesser of the provider's charge or the allowance indicated in the Office of Workers' Compensation administration's CPT code reimbursement manual listing of medical procedures.

B. Maximum allowable reimbursement for respiratory therapy supplies, equipment and related services will be the least of:

1. the provider's usual and customary fee;

2. a pre-negotiated amount between the provider and carrier/self-insured employer; or

3. the amount indicated in the maximum allowable reimbursement schedule.

C. Respiratory Services Equipment

State of Louisiana

Office of Workers' Compensation

Schedule of Maximum Allowances for Respiratory Services Equipment

E0424

Stat comp gas O2 system, rental

$455

E0425

Stat comp gas O2 system, purchase

$4,550

$3,413

E0430

Port gas O2 system, purchase

$2,150

$1,613

E0431

Port gas O2 system, rental

$215

E0433

Portable liquid oxygen sys

$67

E0434

Port liquid O2 system, rental

$223

E0435

Port liquid O2 system, purchase

$2,230

$1,673

E0439

Stat liquid O2 system, rental

$455

E0440

Stat liquid O2 system, purchase

$4,550

$3,413

E0441

O2 contents, gaseous, per unit

$20

E0442

O2 contents, liquid, per unit

E0443

Port O2 contents, gaseous, unit

$10

E0444

Port O2 contents, liquid, unit

100.69

E0450

Volume ventilator; stat/portable

B.R.

B.R.

$1,750

E0455

O2 tent, excl croup/ped tents

B.R.

E0457

Chest shell (cuirass)

$721

$540

$72

E0459

Chest wrap

$534

$400

$53

E0460

Neg pressure vent; port/statonary

$9,053

$6,790

$905

E0461

Vol control vent noninv int

$1,333

E0462

Rocking bed w//w/o side rails

$3,057

$2,293

$306

E0463

Press supp vent invasive int

$1,964

E0464

Press supp vent noninv int

$2,132

E0470

RAD w/o backup non-inv intfc

$309

E0471

RAD w/backup non inv intrfc

$773

E0472

RAD w backup invasive intrfc

$773

E0480

Percussor, elect/pneum, home mod

$670

$503

$67

E0481

Intrpulmnry percuss vent sys

B.R.

B.R.

B.R.

E0482

Cough stimulating device

$600

E0483

Chest compression gen system

$1,485

E0484

Non-elec oscillatory pep dvc

$52

$39

$5

E0485

Oral device/appliance prefab

B.R.

B.R.

B.R.

E0486

Oral device/appliance cusfab

B.R.

B.R.

B.R.

E0487

Electronic spirometer

B.R.

B.R.

B.R.

E0500

IPPB machine, w/built-in Nebuliz

$1,152

$864

$115

E0550

Humidifier, extensive sup humid

$526

$394

$53

E0555

Humidifier, glass/autoclav plast

B.R.

E0560

Humidifier, supplemental humidi

$212

$159

$22

E0565

Compressor, air power source

$640

$480

$64

E0570

Nebulizer, w/compressor

$207

$155

$21

E0572

Aerosol compressor adjust pr

$53

E0574

Ultrasonic generator w svneb

$56

E0575

Nebulizer; ultrasonic

$1,078

$809

$108

E0580

Nebulizer, glass/autoclav plast

$16

E0585

Nebulizer, w/compressor and heater

$433

$325

$43

E0600

Suction pump, home model, port

$491

$368

$50

E0601

Cont airway pressure (CPAP) dev

$1,172

$879

$117

E0605

Vaporizer, room type

$29

$23

$3

E0606

Postural drainage board

$241

$180

$24

E1353

Regulator

E1354

Wheeled cart, port cyl/conc

B.R.

B.R.

B.R.

E1355

Stand/rack

B.R.

E1356

Batt pack/cart, port conc

B.R.

B.R.

B.R.

E1357

Battery charger, port conc

B.R.

B.R.

B.R.

E1358

DC power adapter, port conc

B.R.

B.R.

B.R.

E1372

Immersion ext heater nebulizer

$201

$149

$29

E1405

O2 and water vapor enriching system

B.R.

E1406

O2 and water vapor enriching system

B.R.

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.

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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