LAC 40:I.5153. In State Medical Treatment

A.1. Each employer shall furnish all necessary drugs, supplies, hospital care and services, medical and surgical treatment, and any nonmedical treatment recognized by the laws of this state as legal. All such care, services, and treatment shall be performed at facilities within the state when available. 2. When billing for out-of-state services, supporting documentation is necessary to show that the service being provided cannot be performed within the state, or it is closer to patient's domicile to have services performed out of state. B. The reimbursement allowances of this manual are not applicable to medical services rendered outside the state of Louisiana even though the services are provided under the Louisiana Workers' Compensation Statutes. C. Health Care providers are required to report treatment to the carrier/self insured employer on the: 1. HCFA 1500 Form; 2. UB-92; or 3. ADA - Dental Claim Form. D. Reimbursement for out of state services shall be based on one of the following: 1. the workers' compensation reimbursement schedule for the state in which services are rendered; or 2. the usual and customary fee for the geographic area in which the services are rendered. Editor's Note: In addition, the following Sections of this Chapter are applicable and shall be used for the other Chapters in this Part governing reimbursement. These specific Chapters are: Chapter 31, Vision Care Services; Chapter 33, Hearing Aid Equipment and Services; Chapter 35, Nursing Attendant Care and Home Health Services; Chapter 39, Medical Transportation; Chapter 41, Durable Medical Equipment and Supplies; Chapter 43, Prosthetic and Orthopedic Equipment; Chapter 45, Respiratory Services; Chapter 47, Miscellaneous Claimant Expenses; and Chapter 49, Vocational Rehabilitation Consultant; and Chapter 51, Medical Reimbursement Schedule.