1. A. The following inpatient services are not billable on the UB-92 Form unless they are customarily billed in that manner:

   1. 1. durable medical equipment when charges exceed $150;
   2. 2. orthotic/prosthetic appliance when charges exceed $150 (Pacemakers and other surgically implanted devices may be billed on UB-92);
   3. 3. ambulance;
   4. 4. psychiatric/psychological treatments and services;
   5. 5. therapeutic services;
   6. 6. professional services customarily billed separately must be billed on the HCFA-1500 Claim Form; and

   7. 7. separate sets of billing instructions have been developed for the following services:

      1. a. professional services (including chiropractor and physical therapy);
      2. b. durable medical equipment and supplies;
      3. c. prosthetic and orthotic equipment;
      4. d. medical transportation (ambulance);
      5. e. respiratory therapy; and
      6. f. nursing/home health and attendant services.

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).