Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 51 - Medical Reimbursement Schedule
Section I-5139 - Psychiatry
Universal Citation: LA Admin Code I-5139
Current through Register Vol. 50, No. 9, September 20, 2024
A. General
1. Psychiatric evaluations may be provided as
independent medical examinations (IMEs) when requested by the
carrier/self-insured employer.
2.
Psychiatric evaluations may be provided as consultations when requested by a
physician and when authorized by the carrier/self-insured employer.
3. Upon authorization by the
carrier/self-insured employer psychiatric treatment may be provided when
documentation submitted by the physician to the carrier/self-insured employer
substantiates the medical necessity of the treatment and includes the estimated
length of treatment.
4.
Reimbursement for a routine medical visit rendered by the same physician on the
same day as psychiatric therapy is included in the reimbursement for the more
comprehensive service.
5. Hypnosis
may be reimbursed when it is an integral part of a plan for the treatment of
post-traumatic stress disorders arising from on-the-job injuries.
B. Reimbursement
1. Psychiatric Diagnostic Interview
(Procedure Code 90801). Reimbursement for this service includes history and
mental status determination, development of a treatment plan when treatment is
necessary, and the preparation of a written report.
2. Psychological Testing (Procedure Codes
90830, 95880, 95881, 95882)
a. Reimbursement
for these procedures includes the administration of the test, scoring
interpretation of results and preparation of a written report.
b. In order for appropriate reimbursement to
be made, each test must be specifically identified on the HCFA 1500 Form by the
appropriate procedure code.
c. The
total charge for the test must be entered in Item 24-F on the HCFA 1500
Form.
d. A single unit of service
must be entered in Item 24-G for each test.
3. Medical Psychotherapy (Procedure Codes
90841-90853)
a. Individual psychotherapy must
be billed under the procedure code most closely approximating the length of the
session.
b. Group psychotherapy
generally requires 75 to 90 minutes per session. When a psychiatric treatment
program includes group sessions routinely scheduled for more or less time than
this, appropriate modifiers should be used.
4. Psychiatric services may be reimbursed
when billed by Louisiana licensed physicians who are certified by, or who have
satisfactorily completed the specialized training requirements of, the American
Board of Psychiatry and Neurology or the American Osteopathic Board of
Neurology and Psychiatry. These physicians must either perform the service
directly or provide direct supervision of qualified mental health professionals
performing the service as required under the applicable Louisiana
statutes.
5. Psychiatric
diagnostic, evaluative and therapeutic procedures must be billed under
appropriate CPT procedure codes.
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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