Louisiana Administrative Code
Title 40 - LABOR AND EMPLOYMENT
Part I - Workers' Compensation Administration
Subpart 2 - Medical Guidelines
Chapter 51 - Medical Reimbursement Schedule
Section I-5143 - Thermography
Universal Citation: LA Admin Code I-5143
Current through Register Vol. 50, No. 9, September 20, 2024
A. General Information
1. When medically necessary,
thermographic testing may be used as an assistive device in the diagnosis of
many different conditions.
2. When
a request for authorization for thermography is received, carriers must ensure
that a specially trained, qualified physician is to perform the test and that
written documentation of medical necessity is obtained, when necessary, to
substantiate the service.
3. As
with all diagnostic tests, thermography should be ordered with discretion by
the attending physician and authorized with discretion by the
carrier.
B. Authorization
1. Prior to performing a
thermographic test, thermography test, a physician must request authorization
from the carrier.
2. Upon request,
a physician must submit to the carrier written documentation of medical
necessity for the thermographic testing.
3. Upon request by the carrier, a physician
must submit documentation of certification or credentials supporting his/her
qualifications for the provision of thermography.
4. Thermographic tests must not be authorized
unless the date of service is at least 45 days after the date of accident
unless it is medically necessary to provide the service at an earlier date and
documentation of medical necessity is submitted to the carrier.
C. Body Areas
1. Major Body Areas (The following areas
include all views):
a. head;
b. cervical spine and upper
extremities;
c. lumbosacral spine
and lower extremities.
2. Limited Body Areas (The following areas
include all views):
a. thoracic
spine;
b. any portion of a major
area.
D. Billing
1. When performed to the entire head,
Procedure Code 93760 must be used.
2. When performed to a portion of the head,
e.g., temporomandibular joint, Modifier-52 must be added to 93760 to indicate a
limited area. The exact site must be specified in Item 24-D on the HCFA 1500
Form.
3. When performed to a body
area other than the head, Procedure Code 93762 must be used.
4. When performed to either the thoracic area
or a portion of a major area, e.g., wrist or foot, Modifier-52 must be added to
93762 to indicate a limited area. The exact site must be specified in Item 24-D
on the HCFA 1500 Form.
E. Reimbursement
1. Reimbursement is limited to one body area
either major or limited, unless an additional area(s) is medically necessary
and documentation of medical necessity is submitted to the carrier.
2. Reimbursement for thermography to a major
body area must be at the provider's usual charge or the MRA, whichever is
less.
3. Reimbursement for
thermography to a limited body area must be at the provider's usual charge or
50 percent of the MRA, whichever is less.
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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