La. Admin. Code tit. 40 § I-2905

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

Section I-2905 - Covered Services

A. Drugs prescribed by the treating or a consulting physician for an occupational injury or disease are reimbursable under workers' compensation. If a drug is prescribed for other than primary treatment of the compensable condition the treating physician must provide written justification. For example, a weight control drug may be necessary to reduce a person's weight in order to relieve pain and enable proper strengthening and treatment of a back injury; or, an antidepressant may be prescribed to enhance an analgesic.

B. Durable medical equipment, prosthetics, and nonreusable supplies are also reimbursable to pharmacies but must be billed on the HCFA 1500 Form. National Drug Codes (NDCs) are not acceptable for the billing of supplies. Separate billing instructions are provided for these services. Refer to the appropriate reimbursement schedule.

C. Medication paid for by a claimant will be reimbursed directly to the claimant. In order for the claimant to bill the carrier/self-insured employer, the pharmacist must furnish the claimant with a signed receipt and a nonnegotiable copy of each prescription including the national drug code and quantity. The pharmacy billing must include only the actual amount billed for the amount of drugs being dispensed on any one visit.

La. Admin. Code tit. 40, § I-2905

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.