La. Admin. Code tit. 40 § I-4311

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-4311 - Covered Services

A. Prosthetic/Orthotic Appliances

1. The carrier/self-insured employer will pay only for those orthotic or prosthetic devices prescribed by an authorized physician for a recognized occupational injury or illness. The device must be described in commonly recognized language in accordance with the Schedule of Maximum Allowances included in this document.

2. Repairs and modifications to achieve satisfactory adjustment of an appliance shall be made within 60 days of initial fitting without additional charge by the supplier of the orthotic or prosthetic device. The provider should attach a signed statement from the claimant acknowledging receipt of the item whenever submitting invoices to the carrier/self-insured employer for prosthetic appliances.

3. Neither a myoelectric (bionic) prosthetic appliance or a cosmetic prosthetic appliance will be approved unless the standard, functional version of the prosthesis has been used on a 6-month trial basis. Both versions will not be reimbursed simultaneously.

4. Appliances purchased in connection with a compensable injury may be replaced if medically necessary.

Note: Please consult the Vision Care Services Fee Schedule for information concerning the billing of artificial eyes. A separate fee schedule is also published with billing instructions and rates for durable medical equipment and supplies as well as hearing aid equipment and services.

B. Braces and Other Nonfitted Items. Braces and other items which are not custom fitted, such as collars and prosthetic supplies that are prescribed by the authorized physician, are reimbursable without prior authorization if the provider's usual and customary charge is $50 or less. Prior authorization is also unnecessary for those braces and back supports provided for a claimant's hospital discharge if the charge does not exceed $150. Please indicate "Hospital Discharge" in the "Remarks" section of the invoice whenever appropriate.

C. Orthopedic Shoes. The carrier/self-insured employer will pay for orthopedic or specially constructed shoes following foot injuries only when stock shoes cannot be used or modified at a lesser cost.

La. Admin. Code tit. 40, § I-4311

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

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