LAC 40: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