LAC 40:I.3329. Reimbursement Schedule

A. The following Section, maximum allowable reimbursement, lists the maximum payment allowed for hearing items described by HCPCS codes. Payment will be 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 amount indicated in the maximum allowable reimbursement schedule. State of Louisiana Office of Workers' Compensation Schedule of Maximum Allowances for Hearing Services and Supplies HCPCS | Description | Maximum Allowable V5008 | Hearing screening | $35 V5010 | Assessment for hearing aid | $82 V5011 | Fitting or checking of hearing aid | B.R. V5014 | Repair/modification of a hearing aid | $117 V5020 | Conformity evaluation | $70 V5030 | Hearing aid, monaural, body worn, air conduction | $738 V5040 | Hearing aid, monaural, body worn, bone conduction | $767 V5050 | Hearing aid, monaural, in the ear (full shell only) | $708 V5060 | Hearing aid, monaural, behind the ear | $720 V5070 | Glasses, air conduction | $802 V5080 | Glasses, bone conduction | $838 V5090 | Dispensing fee, unspecified hearing aid | $270 V5095 | Semi-implantable middle ear hearing prosthesis | B.R. V5100 | Hearing aid, bilateral, body worn | $1,061 V5110 | Dispensing fee, bilateral | $287 V5120 | Binaural, body | $1,160 V5130 | Binaural, in the ear (full shell only) | $1,378 V5140 | Binaural, behind the ear | $1,406 V5150 | Binaural, glasses | $1,388 V5160 | Dispensing fee, binaural | $334 V5170 | Hearing aid, cros, in the ear (full shell only) | $958 V5180 | Hearing aid, cros, behind the ear | $896 V5190 | Hearing aid, cros, glasses | $955 V5200 | Dispensing fee, cros | $282 V5210 | Hearing aid, bicros, in the ear (full shell only) | $1,049 V5220 | Hearing aid, bicros, behind the ear | $1,008 V5230 | Hearing aid, bicros, glasses | $1,042 V5240 | Dispensing fee, bicros | $311 V5241 | Dispensing fee, monaural hearing aid, any type | B.R. V5242 | Hearing aid, analog, monaural, cic (completely in the ear canal) | B.R. V5243 | Hearing aid, analog, monaural, itc (in the canal) | B.R. V5244 | Hearing aid, digitally programmable analog, monaural, cic | B.R. V5245 | Hearing aid, digitally programmable, analog, monaural, itc | B.R. V5246 | Hearing aid, digitally programmable analog, monaural, ite (in the ear) | B.R. V5247 | Hearing aid, digitally programmable analog, monaural, bte (behind the ear) | B.R. V5248 | Hearing aid, analog, binaural, cic | B.R. V5249 | Hearing aid, analog, binaural, itc | B.R. V5250 | Hearing aid, digitally programmable analog, binaural, cic | B.R. V5251 | Hearing aid, digitally programmable analog, binaural, itc | B.R. V5252 | Hearing aid, digitally programmable, binaural, ite | B.R. V5253 | Hearing aid, digitally programmable, binaural, bte | B.R. V5254 | Hearing aid, digital, monaural, cic | B.R. V5255 | Hearing aid, digital, monaural, itc | B.R. V5256 | Hearing aid, digital, monaural, ite | B.R. V5257 | Hearing aid, digital, monaural, bte | B.R. V5258 | Hearing aid, digital, binaural, cic | B.R. V5259 | Hearing aid, digital, binaural, itc | B.R. V5260 | Hearing aid, digital, binaural, ite | B.R. V5261 | Hearing aid, digital, binaural, bte | B.R. V5262 | Hearing aid, disposable, any type, monaural | B.R. V5263 | Hearing aid, disposable, any type, binaural | B.R. V5264 | Ear mold/insert, not disposable, any type | B.R. V5265 | Ear mold/insert, disposable, any type | B.R. V5266 | Battery for use in hearing device | B.R. V5267 | Hearing aid supplies / accessories | B.R. V5268 | Assistive listening device, telephone amplifier, any type | B.R. V5269 | Assistive listening device, alerting, any type | B.R. V5270 | Assistive listening device, television amplifier, any type | B.R. V5271 | Assistive listening device, television caption decoder | B.R. V5272 | Assistive listening device, tdd | B.R. V5273 | Assistive listening device, for use with cochlear implant | B.R. V5274 | Assistive listening device, not otherwise specified | B.R. V5275 | Ear impression, each | B.R. V5298 | Hearing aid, not otherwise classified | B.R. V5299 | Hearing aid, not otherwise classified | B.R. V5336 | Repair/modification augmen devise | B.R. V5362 | Speech screening | B.R. V5363 | Language screening | B.R. V5364 | Dysphagia screening | B.R.