La. Admin. Code tit. 40 § I-3511

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

Section I-3511 - Maximum Allowable Reimbursement

A. Payment for nursing/attendant care services, (not to include home infusion therapy) will be made for the least of:

1. the provider's usual and customary fee;

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

3. the maximum allowable amounts as established by these rules.

B. In computing the number of Home Health Agency (HHA) visits rendered a patient eligible for Workers' Compensation benefits, each personal contact in the place of the residence of patient made for the purpose of providing a covered service by a health worker on the staff of a HHA or by others under contract or arrangement with a HHA shall be counted as a visit. A visit made simultaneously by two or more health workers from a HHA to provide a single covered service for which one person supervises or instructs the other shall be counted as one visit.

C. The following shall be used.

Code	Description	Allowance
W0050	Home health agency based health care employee (visit rate)	$100
W0100	Home health agency based registered nurse (hourly rate)	$ 44
W0110	Home health agency based licensed practical nurse (hourly rate)	$ 31
W0120	Home health agency based nurses' aide, (hourly rate)	$ 11
W0125	Home health agency based attendant, (hourly rate)	Minimum Wage
W0200	Self employed registered nurse, (hourly rate)	$ 44
W0210	Self employed licensed practical nurse, (hourly rate)	$ 31
W0220	Self employed nurses' aide, (hourly rate)	$ 11
W0225	Self employed attendant, hourly rate	Min. Wage
W0325	Nonprofessional family member	Min. Wage
Home Infusion Therapy
Per diem allowances reflect the necessary supplies for the safe and effective administration of the prescribed therapy. Supplies include intravenous pump with battery back-up alarm, pump administration sets, IV tubing, central line dressing kits, needles, syringes, saline, heparin, PRN adapters, tape, gauze, IV pole, alcohol pads, start kits, catheters, and other ordinary supplies as needed.
Antibiotic Therapy
	Dosage per Day	Per Diem
W0401	One dose per day	$ 77 + AWP*
W0402	Two doses per day	$ 94 + AWP
W0403	Three doses per day	$110 + AWP
W0404	Four doses per day	$127 + AWP
W0405	Over four doses per day	$143 + AWP
*AWP means Average Wholesale Price as found in the most current monthly update of the Red Book.
Total Parenteral Nutrition
Per diem price reflects daily charge for any combination of standard dextrose, amino acid and additives and includes cost of skilled nurse visit. Lipids 10 percent (500cc) should be included at no additional charge based upon frequency of once a week
	Description	Per Diem
W0502	1.0 to 1.6 liters of TPN daily	$182
W0504	1.7 to 2.4 liters of TPN daily	$215
W0506	2.5 liters or greater of TPN daily	$248
Additional Lipids
Allowance includes tubing and administration supplies.
W0512	Lipids 10% (500ml)	$33
W0514	Lipids 20% (500ml)	$44
W0519	Special formulations	BR
Pain Management
Allowances are based on use of five cassettes per month and include pump and administration sets.
W0602	Pain management, drug and ingredients	$86 + AWP
Additional Cassettes
W0612	50 ML	$39
W0614	100 ML	$50
Hydration
Allowance per day reflects use of standard fluids and supplies.
W0702	One liter daily	$58
W0704	Two liters daily	$66
W0706	Three liters daily	$75
W0708	Four liters daily	$84
Chemotherapy
W0802	Continuous infusion	$99 + AWP
W0804	Bolus/push	$88 + AWP
W0806	Intermittent infusion	$50 + AWP
Enteral Therapy
W0902	Enteral nutrient	$22 + AWP

La. Admin. Code tit. 40, § I-3511

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.