LAC 40:I.3329
A. The following Section, maximum allowable reimbursement, lists the maximum payment allowed for hearing items described by HCPCS codes. Payment will be the least of:
3. the amount indicated in the maximum allowable reimbursement schedule.
| State of Louisiana Office of Workers' Compensation Schedule of Maximum Allowances for Hearing Services and Supplies | ||
| HCPCS | Description | Maximum Allowable |
| V5008 | Hearing screening | $35 |
| V5010 | Assessment for hearing aid | $82 |
| V5011 | Fitting or checking of hearing aid | B.R. |
| V5014 | Repair/modification of a hearing aid | $117 |
| V5020 | Conformity evaluation | $70 |
| V5030 | Hearing aid, monaural, body worn, air conduction | $738 |
| V5040 | Hearing aid, monaural, body worn, bone conduction | $767 |
| V5050 | Hearing aid, monaural, in the ear (full shell only) | $708 |
| V5060 | Hearing aid, monaural, behind the ear | $720 |
| V5070 | Glasses, air conduction | $802 |
| V5080 | Glasses, bone conduction | $838 |
| V5090 | Dispensing fee, unspecified hearing aid | $270 |
| V5095 | Semi-implantable middle ear hearing prosthesis | B.R. |
| V5100 | Hearing aid, bilateral, body worn | $1,061 |
| V5110 | Dispensing fee, bilateral | $287 |
| V5120 | Binaural, body | $1,160 |
| V5130 | Binaural, in the ear (full shell only) | $1,378 |
| V5140 | Binaural, behind the ear | $1,406 |
| V5150 | Binaural, glasses | $1,388 |
| V5160 | Dispensing fee, binaural | $334 |
| V5170 | Hearing aid, cros, in the ear (full shell only) | $958 |
| V5180 | Hearing aid, cros, behind the ear | $896 |
| V5190 | Hearing aid, cros, glasses | $955 |
| V5200 | Dispensing fee, cros | $282 |
| V5210 | Hearing aid, bicros, in the ear (full shell only) | $1,049 |
| V5220 | Hearing aid, bicros, behind the ear | $1,008 |
| V5230 | Hearing aid, bicros, glasses | $1,042 |
| V5240 | Dispensing fee, bicros | $311 |
| V5241 | Dispensing fee, monaural hearing aid, any type | B.R. |
| V5242 | Hearing aid, analog, monaural, cic (completely in the ear canal) | B.R. |
| V5243 | Hearing aid, analog, monaural, itc (in the canal) | B.R. |
| V5244 | Hearing aid, digitally programmable analog, monaural, cic | B.R. |
| V5245 | Hearing aid, digitally programmable, analog, monaural, itc | B.R. |
| V5246 | Hearing aid, digitally programmable analog, monaural, ite (in the ear) | B.R. |
| V5247 | Hearing aid, digitally programmable analog, monaural, bte (behind the ear) | B.R. |
| V5248 | Hearing aid, analog, binaural, cic | B.R. |
| V5249 | Hearing aid, analog, binaural, itc | B.R. |
| V5250 | Hearing aid, digitally programmable analog, binaural, cic | B.R. |
| V5251 | Hearing aid, digitally programmable analog, binaural, itc | B.R. |
| V5252 | Hearing aid, digitally programmable, binaural, ite | B.R. |
| V5253 | Hearing aid, digitally programmable, binaural, bte | B.R. |
| V5254 | Hearing aid, digital, monaural, cic | B.R. |
| V5255 | Hearing aid, digital, monaural, itc | B.R. |
| V5256 | Hearing aid, digital, monaural, ite | B.R. |
| V5257 | Hearing aid, digital, monaural, bte | B.R. |
| V5258 | Hearing aid, digital, binaural, cic | B.R. |
| V5259 | Hearing aid, digital, binaural, itc | B.R. |
| V5260 | Hearing aid, digital, binaural, ite | B.R. |
| V5261 | Hearing aid, digital, binaural, bte | B.R. |
| V5262 | Hearing aid, disposable, any type, monaural | B.R. |
| V5263 | Hearing aid, disposable, any type, binaural | B.R. |
| V5264 | Ear mold/insert, not disposable, any type | B.R. |
| V5265 | Ear mold/insert, disposable, any type | B.R. |
| V5266 | Battery for use in hearing device | B.R. |
| V5267 | Hearing aid supplies / accessories | B.R. |
| V5268 | Assistive listening device, telephone amplifier, any type | B.R. |
| V5269 | Assistive listening device, alerting, any type | B.R. |
| V5270 | Assistive listening device, television amplifier, any type | B.R. |
| V5271 | Assistive listening device, television caption decoder | B.R. |
| V5272 | Assistive listening device, tdd | B.R. |
| V5273 | Assistive listening device, for use with cochlear implant | B.R. |
| V5274 | Assistive listening device, not otherwise specified | B.R. |
| V5275 | Ear impression, each | B.R. |
| V5298 | Hearing aid, not otherwise classified | B.R. |
| V5299 | Hearing aid, not otherwise classified | B.R. |
| V5336 | Repair/modification augmen devise | B.R. |
| V5362 | Speech screening | B.R. |
| V5363 | Language screening | B.R. |
| V5364 | Dysphagia screening | B.R. |
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), amended by the Workforce Commission, Office of Workers’ Compensation, LR 39:1840 (July 2013).