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

   1. 1. ambulance;
   2. 2. psychiatric/psychological treatments and services;
   3. 3. therapeutic services;
   4. 4. all professional services including those provided by salaried personnel that are customarily billed separately and those provided in connection with emergency room service. These type of professional services must be billed on the HCFA-1500 Form;
   5. 5. outpatient clinic services; and
   6. 6. all outpatient durable medical and prosthetic/orthotic items.

2. B. Separate sets of billing instructions/fee schedules have been developed for the following services:

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

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).