Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 23 - Regulation 48-Standardized Claims Forms › Section XIII-2303 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
CDT-1 Codes
- the current dental terminology
				  prescribed by the American Dental Association.
CPT-4 Codes
- the current procedural
				  terminology published by the American Medical Association.
HCFA
- the Federal Health Care Financing
				  Administration of the U.S. Department of Health and Human Services.
HCFA for UB92
- the health insurance claim
				  form published by HCFA for use by institutional care providers.
HCFA Form 1500
- the health insurance claim
				  form published by HCFA for use by health care providers.
HCPCS
- HCFA's common procedure coding system
				  which is based upon the AMA's
Physician Current Procedural Terminology,
				  Fourth Edition
(CPT-4).
1.
HCPCS Level I Codes
- the AMA's CPT-4 codes
				  with the exception of anesthesiology services.
2.
HCPCS Level 2 Codes
- the codes for
				  physician and nonphysician services are not included in COT-4.
Health Care Provider
-
1. an acupuncturist licensed under R.S. 37:1356-1360;
2. a certified registered nurse anesthetist licensed under
				  R.S.
				  37:930;
3. a chiropractor licensed under R.S. 37:2801-2830.7;
4. a dentist licensed under R.S. 37:751-794;
5. a dietician and nutritionist licensed under R.S.
				  37:3081-3093 and
				  36:259 U;
6. durable medical equipment suppliers;
7. an emergency medical technician licensed under R.S.
				  40:1231-1232;
8. a general health clinic (excluding early periodic
				  screening diagnosis treatment clinics) certified by the Louisiana Department of
				  Health and Hospitals;
9. a hearing aid dealer licensed under R.S. 37:2441-2465;
10. a licensed practical nurse licensed under
				  R.S.
				  37:961;
11. a mental health counselor licensed under R.S.
				  37:1101-1115;
12. a mental health clinic licensed under
				  R.S.
				  28:567;
13. a midwife licensed under R.S. 37:3240-3257;
14. an occupational therapist licensed under R.S.
				  37:3001-3014;
15. an optometrist licensed under
				  R.S.
				  37:1052;
16. a physical therapist and physical therapist assistant
				  licensed under R.S. 37:2401-2419;
17. a physician licensed under R.S. 37:1261-1292;
18. a physician assistant licensed under
				  R.S.
				  37:1360.21-27;
19. a podiatrist licensed under R.S. 37:611-628;
20. a psychologist licensed under R.S. 37:2351-2370;
21. a registered nurse licensed under R.S. 37:911-931;
22. a rehabilitation center licensed under 42:CFR
				  405.1701Q;
23. a respiratory therapist licensed under R.S.
				  37:3351-3361;
24. a social worker licensed under R.S. 37:2701-2718;
25. a speech pathologist and audiologist licensed under R.S.
				  2651-2665;
26. a substance abuse counselor licensed under R.S.
				  37:3371-3384;
27. a substance abuse prevention/treatment program licensed
				  under
				  R.S.
				  40:1058.1-1058.3;
28. a free standing ambulatory surgical center licensed under
				  R.S. 40:2131-2141;
29. any other health care providers as licensed by the state
				  of Louisiana;
ICD-9-CM Codes
- the disease codes in the
International Classification of Diseases, Ninth Revision,
clinical modifications published by the U.S. Department of Health and Human
				  Services.
Institutional Care Provider
-
1. an adult day health care provider licensed under R.S.
				  46:1971-1980;
2. an ambulatory surgical center licensed under R.S.
				  40:2131-2143;
3. a drug screening laboratory licensed under R.S.
				  49:1111-1113, 1115-1118, 1121, 1122, and 1125;
4. an end stage renal dialysis facility under 42:CFR
				  405.2100;
5. a home health agency licensed under
				  R.S.
				  40:2009.31-2009.40;
6. a hospice licensed under R.S. 40:2181-2191;
7. a hospital licensed under R.S. 40:2100-2114;
8. a nursing home licensed under
				  R.S.
				  40:2009;
9. a residential care/community group home or residential
				  facility licensed under R.S. 46:51, 1401-1411, and 28:1-284;
10. any other institutional care provider as licensed by the
				  state of Louisiana.
J512 Form
- the uniform dental claim form
				  approved by the American Dental Association for use by dentists.
Medicaid
- Title XIX of the Federal Social
				  Security Act.
Medicare
- Title XVIll of the Federal Social
				  Security Act.
Revenue Codes
- the codes established for use
				  by institutional care providers by the National Uniform Billing
				  Committee.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.22:10,
				  22:213(A)(14),
				  and
				  22:3016(C)
				  of the Insurance Code.