Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 51 - Medical Reimbursement Schedule
Section I-5137 - Neurologic and Neuromuscular Services
Universal Citation: LA Admin Code I-5137
Current through Register Vol. 50, No. 9, September 20, 2024
A. General
1. Neurologic services are typically
consultation services and any of the levels of consultation (Procedure Codes
99241-99263) may be appropriate. However, when one is the attending physician
for or partial care, the appropriate evaluation and management level of service
must be billed.
2. Diagnostic
studies (nerve conduction tests, electromyograms, electroencephalograms, etc.)
are reimbursable in addition to the office visit or consultative
service.
3. Diagnostic study
includes both a technical component (equipment, technical personnel, supplies,
etc.) and a professional component (interpreting test results, written reports,
etc.).
4. Billing of the five-digit
CPT neurological and neuromuscular procedure codes indicate that the complete
service (professional and technical components) is being billed. Reimbursement
is the lesser of the provider's charge or the MRA for the procedure.
5. When the professional and technical
components are performed by two different health care providers, the total
reimbursement for both components must not exceed the listed MRA.
a. The physician bills for the test
interpretation and written report by adding Modifier-26 to the five-digit
procedure code. The reimbursement is the lesser of the provider's charge or the
MRA listed for the five digit procedure code plus Modifier-26.
b. The health care provider who performs the
technical component bills for the technical component by adding Modifier-90 to
the five digit procedure code. The reimbursement for the technical component is
the lesser if the provider's charge or the difference between the MRA for the
total procedure and the MRA for the five-digit procedure code plus
Modifier-90.
c. When a procedure
coded does not list a separate amount for the professional component,
reimbursement for the professional component must not exceed 85 percent of the
total MRA. The reimbursement for the technical component must not exceed 15
percent of the total MRA.
6. When the diagnostic services are provided
at a hospital or ambulatory surgical center, the hospital or ambulatory
surgical center bills for the technical services and the physician bills for
the professional component only, using Modifier-26.
B. Specific
1. Extremity Testing, Muscle Testing and
Range of Motion (ROM) Measurements (Procedure Codes 95831-95852 and
97720-97752)
a. Visits/Consultations
i. When a visit/consultation is made for the
purpose of an assessment and evaluation of the patient, the visit/consultation
may be reimbursed at the appropriate level of service. Extremity, muscle and
ROM tests and measurements performed during the visit must not be reimbursed as
separate entities. As these tests are an integral part of the
visit/consultation, reimbursement for these tests and measurements is included
in the reimbursement for the visit/consultation.
ii. When an office visit/consultation is made
solely for the purpose of performing tests and measurements, these testing
procedures may be reimbursed as separate entities. Reimbursement must not be
made for a visit in addition to the test.
b. When performed as separate procedures,
muscle testing and range of motion measurements require objective measurements
of the muscle and joint functions being tested. For reimbursement to be made,
reports showing these measurements must accompany the billing of these
codes.
c. Procedure Code 97752 must
be used when testing is performed by means of mechanical equipment.
d. Reimbursement
i. Reimbursement for extremity testing,
muscle testing and range of motion measurements may be made only one in a
30-day period for the same body area.
ii. When two or more procedures from 95831
through 95852 are performed for the same patient by the same physician on the
same date of service, the total reimbursement allowance may not exceed the
reimbursement for Procedure Code 95834 (total evaluation of body, including
hands).
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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