LAC 50:XV.20701. Outpatient Services

A. A “638” facility shall provide preventive, diagnostic, therapeutic, rehabilitative or palliative services that are furnished to outpatients by or under the direction of a: 1. physician; 2. dentist; 3. physician’s assistant; 4. psychologist or licensed counselor; 5. nurse practitioner, nurse midwife or clinical nurse specialist; 6. x-ray technician; or 7. pharmacist. B. The facility shall furnish covered services as an “encounter”, which is defined as a face-to-face visit between a facility health professional and an eligible patient for the purpose of providing outpatient services. An encounter shall, at a minimum, consist of the following: 1. A detailed history (chief complaint, history of present illness, problem pertinent system review, pertinent past history/social); 2. A detailed exam (extended exam of the affected body area(s) and other symptomatic or related organ systems); and. 3. Low to moderate complexity of medical decision making based on the number of possible diagnoses/management options; the amount and complexity of medical records, diagnostic tests and other information to be reviewed; and the risk of complications, morbidity and/or mortality associated with the patient’s presenting problems. C. The following services shall be provided on-site by the “638” facility and included as part of the encounter: 1. physician and mid-level practitioner services; 2. dental services; 3. psychological services; 4. prescription drugs services; 5. laboratory services; 6. x-ray services; and 7. nutrition services. D. The facility may not bill an encounter rate if the only “services” performed were tasks incidental to services including, but not limited to: 1. taking blood pressure and temperature; 2. giving an injection; 3. changing dressings; 4. diagnostic procedures; 5. laboratory services such as EKG, Peak Flow, Spirometry Respiratory Flow Volume, Loop and injections; or 6. a referral for other services.