La. Admin. Code tit. 40, § I-3329 - Reimbursement Schedule

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:

1. the provider's usual and customary fee;

2. a pre-negotiated amount between the provider and carrier/self-insured employer; or

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.

Notes

La. Admin. Code tit. 40, § I-3329

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).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.