La. Admin. Code tit. 40 § I-4733

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

Section I-4733 - Schedule of Maximum Allowances

A. General Guidelines

1. Maximum reimbursement allowances have been established for most of the services required by workers' compensation claimants. The maximum allowable reimbursement can generally be found in one of the following manuals:

a.CPT Code Reimbursement Manual- this manual contains reimbursement allowances for services described by CPT-4 codes, i.e., dental, surgical, radiology, pathology, and medical procedures;

b. pharmacy reimbursement manual;

c. vision care services reimbursement manual;

d. vocational rehabilitation services reimbursement manual;

e. home and vehicle modification reimbursement manual;

f. hospital reimbursement manual;

g. hearing aid equipment reimbursement manual;

h. respiratory services reimbursement manual;

i. durable medical equipment reimbursement manual;

j. nursing attendant care reimbursement manual;

k. prosthetic and orthopedic equipment reimbursement manual;

l. medical transportation reimbursement manual.

2. Each of the above manuals limits payment to the least of:

a. the provider's usual and customary fee;

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

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

B. Individual Consideration Items/Services. Many services considered "miscellaneous" in nature cannot be pre-determined and no maximum allowance can be scheduled. The primary method of cost control for these items is totally within the purview of the carrier/self-insured employer. It is logical for the carrier/self-insured employer to set a limit which can be approved without investigation or comparative pricing. Any charges above the carrier/self-insured employer established parameter should be subject to comparative pricing review by the carrier/self-insured employer. Some of the items for which no reimbursement allowances have been established are:

1. pharmacy-nonprescription needs;

2. books for rehabilitation training;

3. room and board fees to obtain medical and nonmedical treatment; and

4. injections.

C. Statutory Reimbursement Limitations. Certain services are limited in reimbursement by statute. These are:

1. mileage expenses-reimbursement shall be at the same rate per mile as established by the state of Louisiana for reimbursement of state employees (R.S. 23:1203). The carrier/self-insured employer shall inform claimants of their right to reimbursement for mileage. The next page contains a Mileage Reimbursement Log for filing mileage expense;

2. burial expenses-reimbursement for burial expenses is limited by statute (R.S. 23:1210) to $3,000.

D. Mileage Reimbursement Log

Mileage Reimbursement Log

________ _______________ ____________ _______________

Claimant Social Security Number Period Beginning Period Ending

Place Traveled		Date	Mileage	Total ($)
From	To
		Totals:

Instructions for Completion of Form:

Claimant- enter your name.

Social Security Number- enter your Social Security number.

Period Beginning- enter first date of travel on this log.

Period Ending- enter last date of travel on this log.

Place Traveled From- enter the street address of starting point.

Place Traveled To- enter the street address of destination.

Date- enter date of travel.

Mileage- enter number of miles traveled.

Total ($)- enter product of miles traveled times mileage reimbursement allowance (miles x cents per mile).

Totals- enter sum of Mileage column and the sum of Total ($) column.

La. Admin. Code tit. 40, § I-4733

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.