La. Admin. Code tit. 50 § XV-20701

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

Section XV-20701 - Outpatient Services

A. A "638" facility shall provide preventive, diagnostic, therapeutic, rehabilitative or palliative services that are furnished to outpatients by or under the direction of a:

1. physician;

2. dentist;

3. physician's assistant;

4. psychologist or licensed counselor;

5. nurse practitioner, nurse midwife or clinical nurse specialist;

6. x-ray technician; or

7. pharmacist.

B. The facility shall furnish covered services as an "encounter", which is defined as a face-to-face visit between a facility health professional and an eligible patient for the purpose of providing outpatient services. An encounter shall, at a minimum, consist of the following:

1. A detailed history (chief complaint, history of present illness, problem pertinent system review, pertinent past history/social);

2. A detailed exam (extended exam of the affected body area(s) and other symptomatic or related organ systems); and.

3. Low to moderate complexity of medical decision making based on the number of possible diagnoses/management options; the amount and complexity of medical records, diagnostic tests and other information to be reviewed; and the risk of complications, morbidity and/or mortality associated with the patient's presenting problems.

C. The following services shall be provided on-site by the "638" facility and included as part of the encounter:

1. physician and mid-level practitioner services;

2. dental services;

3. psychological services;

4. prescription drugs services;

5. laboratory services;

6. x-ray services; and

7. nutrition services.

D. The facility may not bill an encounter rate if the only "services" performed were tasks incidental to services including, but not limited to:

1. taking blood pressure and temperature;

2. giving an injection;

3. changing dressings;

4. diagnostic procedures;

5. laboratory services such as EKG, Peak Flow, Spirometry Respiratory Flow Volume, Loop and injections; or

6. a referral for other services.

La. Admin. Code tit. 50, § XV-20701

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:2029 (August 2005).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, and Title XIX of the Social Security Act.