1. A. Inpatient. Reimbursement for inpatient psychiatric and/or chemical dependency unit services will be limited to the lesser of covered billed charges or the per diem amount.

   1. 1. The uniform statewide per diem rates will be applied to inpatient days by type of service, either psychiatric or chemical dependency.

   2. 2. The reimbursement amount will be reduced by charges for noncovered items and services.

      Per Diem Rate Schedule
      Psychiatric Services	$799
      Chemical Dependency Unit Services	$597

   3. 3. Using the above per diems, the formula for calculating payment amount is the same as that for acute care inpatient services found in §2505.B.1.

2. B. Outpatient. Psychiatric and chemical dependency services rendered on an outpatient basis by professional providers such as medical doctors, Ph.D. psychologists, and social workers will be reimbursed based on the medical reimbursement schedule for related CPT-4 Procedure Codes promulgated by the state of Louisiana, Office of Workers' Compensation. Any facility fees associated with providing these professional services will be reimbursed at covered charges less a 10 percent discount. The formula for calculating payment amount is:

   (Billed Charges) - (Noncovered Charges) = Covered Charges x 0.90 = Payment Amount

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.

Historical Note

HISTORICAL NOTE: 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).