1. A. Itemization

   1. 1. Billing for hospital and other institutional type services must be submitted on a UB-92 Form as developed and implemented by the National Uniform Billing (UB-92) Committee. A copy of this form is on the last page of this Section.
   2. 2. Please itemize inpatient charges with the applicable UB-92 revenue codes. The use of all inclusive accommodation and ancillary revenue codes is not acceptable. These codes may contain services which are noncovered.
   3. 3. Invalid revenue codes which are not assigned or defined in the UB-92 manual are not allowed.
   4. 
      4. Sample UB-92 Form

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:121034.2.

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).