Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 33 - Hearing Aid Equipment and Services Reimbursement Schedule, Billing Instructions and Maintenance Procedures › Section I-3329 - Reimbursement Schedule

Current through Register Vol. 50, No. 6, June 20, 2024
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.