LAC 40:I.2533
A. The following revenue codes must be billed on the HCFA 1500 Form.
| Revenue Code(s) | Description |
|---|---|
| 274 | Medical/Surgical Supplies Prosthetics |
| 277 | Medical/Surgical Supplies Take Home Oxygen |
| 290 | Durable Medical Equipment (DME) General Classification |
| 291 | DME-Rental |
| 292 | DME-Purchase |
| 299 | DME-Other Equipment |
| 500-539 | Outpatient Services, Clinic, Free-Standing Clinic and Osteopathic Services |
| 570-599 | Home Health Services |
| 540-549 | Ambulance Services |
| 550-559 | Skilled Nursing |
| 820-859 | Dialysis Service |
| 860-879 | Not Assigned |
| 880-889 | Miscellaneous Dialysis Services |
| 900-909 | Psychiatric/Psychological Treatments |
| 910-919 | Psychiatric/Psychological Services |
| 940-949 | Therapeutic Services |
| 960-989 | Professional Fees |
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.
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).