La. Admin. Code tit. 40 § I-5143

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-5143 - Thermography

A. General Information

1. When medically necessary, thermographic testing may be used as an assistive device in the diagnosis of many different conditions.

2. When a request for authorization for thermography is received, carriers must ensure that a specially trained, qualified physician is to perform the test and that written documentation of medical necessity is obtained, when necessary, to substantiate the service.

3. As with all diagnostic tests, thermography should be ordered with discretion by the attending physician and authorized with discretion by the carrier.

B. Authorization

1. Prior to performing a thermographic test, thermography test, a physician must request authorization from the carrier.

2. Upon request, a physician must submit to the carrier written documentation of medical necessity for the thermographic testing.

3. Upon request by the carrier, a physician must submit documentation of certification or credentials supporting his/her qualifications for the provision of thermography.

4. Thermographic tests must not be authorized unless the date of service is at least 45 days after the date of accident unless it is medically necessary to provide the service at an earlier date and documentation of medical necessity is submitted to the carrier.

C. Body Areas

1. Major Body Areas (The following areas include all views):

a. head;

b. cervical spine and upper extremities;

c. lumbosacral spine and lower extremities.

2. Limited Body Areas (The following areas include all views):

a. thoracic spine;

b. any portion of a major area.

D. Billing

1. When performed to the entire head, Procedure Code 93760 must be used.

2. When performed to a portion of the head, e.g., temporomandibular joint, Modifier-52 must be added to 93760 to indicate a limited area. The exact site must be specified in Item 24-D on the HCFA 1500 Form.

3. When performed to a body area other than the head, Procedure Code 93762 must be used.

4. When performed to either the thoracic area or a portion of a major area, e.g., wrist or foot, Modifier-52 must be added to 93762 to indicate a limited area. The exact site must be specified in Item 24-D on the HCFA 1500 Form.

E. Reimbursement

1. Reimbursement is limited to one body area either major or limited, unless an additional area(s) is medically necessary and documentation of medical necessity is submitted to the carrier.

2. Reimbursement for thermography to a major body area must be at the provider's usual charge or the MRA, whichever is less.

3. Reimbursement for thermography to a limited body area must be at the provider's usual charge or 50 percent of the MRA, whichever is less.

La. Admin. Code tit. 40, § I-5143

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.