La. Admin. Code tit. 40 § I-5137
Current through Register Vol. 50, No. 9, September 20, 2024
Section I-5137 - Neurologic and Neuromuscular ServicesA. General 1. Neurologic services are typically consultation services and any of the levels of consultation (Procedure Codes 99241-99263) may be appropriate. However, when one is the attending physician for or partial care, the appropriate evaluation and management level of service must be billed.2. Diagnostic studies (nerve conduction tests, electromyograms, electroencephalograms, etc.) are reimbursable in addition to the office visit or consultative service.3. Diagnostic study includes both a technical component (equipment, technical personnel, supplies, etc.) and a professional component (interpreting test results, written reports, etc.).4. Billing of the five-digit CPT neurological and neuromuscular procedure codes indicate that the complete service (professional and technical components) is being billed. Reimbursement is the lesser of the provider's charge or the MRA for the procedure.5. When the professional and technical components are performed by two different health care providers, the total reimbursement for both components must not exceed the listed MRA. a. The physician bills for the test interpretation and written report by adding Modifier-26 to the five-digit procedure code. The reimbursement is the lesser of the provider's charge or the MRA listed for the five digit procedure code plus Modifier-26.b. The health care provider who performs the technical component bills for the technical component by adding Modifier-90 to the five digit procedure code. The reimbursement for the technical component is the lesser if the provider's charge or the difference between the MRA for the total procedure and the MRA for the five-digit procedure code plus Modifier-90.c. When a procedure coded does not list a separate amount for the professional component, reimbursement for the professional component must not exceed 85 percent of the total MRA. The reimbursement for the technical component must not exceed 15 percent of the total MRA.6. When the diagnostic services are provided at a hospital or ambulatory surgical center, the hospital or ambulatory surgical center bills for the technical services and the physician bills for the professional component only, using Modifier-26.B. Specific 1. Extremity Testing, Muscle Testing and Range of Motion (ROM) Measurements (Procedure Codes 95831-95852 and 97720-97752) a. Visits/Consultations i. When a visit/consultation is made for the purpose of an assessment and evaluation of the patient, the visit/consultation may be reimbursed at the appropriate level of service. Extremity, muscle and ROM tests and measurements performed during the visit must not be reimbursed as separate entities. As these tests are an integral part of the visit/consultation, reimbursement for these tests and measurements is included in the reimbursement for the visit/consultation.ii. When an office visit/consultation is made solely for the purpose of performing tests and measurements, these testing procedures may be reimbursed as separate entities. Reimbursement must not be made for a visit in addition to the test.b. When performed as separate procedures, muscle testing and range of motion measurements require objective measurements of the muscle and joint functions being tested. For reimbursement to be made, reports showing these measurements must accompany the billing of these codes.c. Procedure Code 97752 must be used when testing is performed by means of mechanical equipment.d. Reimbursement i. Reimbursement for extremity testing, muscle testing and range of motion measurements may be made only one in a 30-day period for the same body area.ii. When two or more procedures from 95831 through 95852 are performed for the same patient by the same physician on the same date of service, the total reimbursement allowance may not exceed the reimbursement for Procedure Code 95834 (total evaluation of body, including hands).La. Admin. Code tit. 40, § I-5137
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.