1. A. Maximum allowable reimbursement for compensable professional respiratory therapy services will be based upon the lesser of the provider's charge or the allowance indicated in the Office of Workers' Compensation administration's CPT code reimbursement manual listing of medical procedures.

2. B. Maximum allowable reimbursement for respiratory therapy supplies, equipment and related services will be the least of:

   1. 1. the provider's usual and customary fee;
   2. 2. a pre-negotiated amount between the provider and carrier/self-insured employer; or
   3. 3. the amount indicated in the maximum allowable reimbursement schedule.

3. C. Respiratory Services Equipment

   State of Louisiana Office of Workers' Compensation Schedule of Maximum Allowances for Respiratory Services Equipment
   E0424	Stat comp gas O2 system, rental			$455
   E0425	Stat comp gas O2 system, purchase	$4,550	$3,413
   E0430	Port gas O2 system, purchase	$2,150	$1,613
   E0431	Port gas O2 system, rental			$215
   E0433	Portable liquid oxygen sys			$67
   E0434	Port liquid O2 system, rental			$223
   E0435	Port liquid O2 system, purchase	$2,230	$1,673
   E0439	Stat liquid O2 system, rental			$455
   E0440	Stat liquid O2 system, purchase	$4,550	$3,413
   E0441	O2 contents, gaseous, per unit	$20
   E0442	O2 contents, liquid, per unit
   E0443	Port O2 contents, gaseous, unit	$10
   E0444	Port O2 contents, liquid, unit	100.69
   E0450	Volume ventilator; stat/portable	B.R.	B.R.	$1,750
   E0455	O2 tent, excl croup/ped tents	B.R.
   E0457	Chest shell (cuirass)	$721	$540	$72
   E0459	Chest wrap	$534	$400	$53
   E0460	Neg pressure vent; port/statonary	$9,053	$6,790	$905
   E0461	Vol control vent noninv int			$1,333
   E0462	Rocking bed w//w/o side rails	$3,057	$2,293	$306
   E0463	Press supp vent invasive int			$1,964
   E0464	Press supp vent noninv int			$2,132
   E0470	RAD w/o backup non-inv intfc			$309
   E0471	RAD w/backup non inv intrfc			$773
   E0472	RAD w backup invasive intrfc			$773
   E0480	Percussor, elect/pneum, home mod	$670	$503	$67
   E0481	Intrpulmnry percuss vent sys	B.R.	B.R.	B.R.
   E0482	Cough stimulating device			$600
   E0483	Chest compression gen system			$1,485
   E0484	Non-elec oscillatory pep dvc	$52	$39	$5
   E0485	Oral device/appliance prefab	B.R.	B.R.	B.R.
   E0486	Oral device/appliance cusfab	B.R.	B.R.	B.R.
   E0487	Electronic spirometer	B.R.	B.R.	B.R.
   E0500	IPPB machine, w/built-in Nebuliz	$1,152	$864	$115
   E0550	Humidifier, extensive sup humid	$526	$394	$53
   E0555	Humidifier, glass/autoclav plast	B.R.
   E0560	Humidifier, supplemental humidi	$212	$159	$22
   E0565	Compressor, air power source	$640	$480	$64
   E0570	Nebulizer, w/compressor	$207	$155	$21
   E0572	Aerosol compressor adjust pr			$53
   E0574	Ultrasonic generator w svneb			$56
   E0575	Nebulizer; ultrasonic	$1,078	$809	$108
   E0580	Nebulizer, glass/autoclav plast			$16
   E0585	Nebulizer, w/compressor and heater	$433	$325	$43
   E0600	Suction pump, home model, port	$491	$368	$50
   E0601	Cont airway pressure (CPAP) dev	$1,172	$879	$117
   E0605	Vaporizer, room type	$29	$23	$3
   E0606	Postural drainage board	$241	$180	$24
   E1353	Regulator
   E1354	Wheeled cart, port cyl/conc	B.R.	B.R.	B.R.
   E1355	Stand/rack	B.R.
   E1356	Batt pack/cart, port conc	B.R.	B.R.	B.R.
   E1357	Battery charger, port conc	B.R.	B.R.	B.R.
   E1358	DC power adapter, port conc	B.R.	B.R.	B.R.
   E1372	Immersion ext heater nebulizer	$201	$149	$29
   E1405	O2 and water vapor enriching system	B.R.
   E1406	O2 and water vapor enriching system	B.R.

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), amended by the Workforce Commission, Office of Workers’ Compensation, LR 39:1854 (July 2013).