Fee Schedules


The following list consists of Fee Schedules used by Louisiana Medicaid Providers. 

Fee Schedules Description
ADHC Waiver Services/Procedure Codes/Rate Chart Fee Schedule for the Adult Day Health Care Waiver Program
American Indian 638 Facilities Rates Page (PDF Format) Fee schedules page for American Indian 638 Facilities.
Ambulance Fee Schedule (PDF Format) Fee Schedule for Louisiana Medicaid Ambulance Transportation.
Dental Fee Schedule Listings Fee Schedules for Adult Denture, EPSDT, and Expanded Dental Services for Pregnant Women (EDSPW)  programs for given dates of service.
DME Enteral Nutrition Fee Schedule (PDF Format) Fee Schedule for Louisiana Medicaid Enteral Nutrition Products
DMEPOS Fee Schedule Fee Schedule for the Louisiana Medicaid DMEPOS Program
EPSDT Early Intervention Services (Early Steps) Fee Schedules Fee schedules for the Louisiana Medicaid EarlySteps Program for the given dates of service. Updated 03/14
EPSDT Psychological and Behavioral Services Fee Schedule for Dates of Service on or after December 18, 2006 (PDF Format) Fee schedule for EPSDT Psychological and Behavioral Services for the given dates of service.
Federal Qualified Health Centers (FQHC) PPS Rates Page Fee schedules page for Federally Qualified Health Centers.
Greater New Orleans Community Health Connection (GNOCHC) Fee Schedule Fee Schedule for the Greater New Orleans Community Health Connection for the given dates of service.
Home Health Services Fee Schedule (PDF Format) Current Fee Schedule for Home Health Services.
Added 06/09
Hospice Rates Hospice Rates, MSA Codes and Revenue Codes for Louisiana Hospice Program effective 10/1/2011.
Immunization Fee Schedules Page Fee Schedules for Immunizations of:
- Children/Adolescents (birth through 18 years);
- 19 & 20 year old enrollees;
- Adults (age 21 years and older)
Immunization Administration – ACA Enhanced Reimbursement Fee Schedule: Age 0 - 18
(effective 1/1/14) (PDF Format)

Immunization Administration – ACA Enhanced Reimbursement Fee Schedule: Age 19 & Older
(effective 1/1/14) (PDF Format)
Fee Schedules for Affordable Care Act Immunization Administration of:
- Children/Adolescents (birth through 18 years);
- Adults (age 19 years and older)
 
Rates effective January 1, 2013 – December 31, 2014. Updated 07/10
Immunization Administration – ACA Enhanced Reimbursement Fee Schedule: Age 0 - 18
(effective 1/1/13) (PDF Format)

Immunization Administration – ACA Enhanced Reimbursement Fee Schedule: Age 19 & Older
(effective 1/1/13) (PDF Format)
Fee Schedules for Affordable Care Act Immunization Administration of:
- Children/Adolescents (birth through 18 years);
- Adults (age 19 years and older)
 
Rates effective January 1, 2013 – December 31, 2014. Updated 07/10
KIDMED Program Fee Schedules Page (PDF Format) Fee Schedules for the KIDMED Program (EPSDT Medical, Vision, and Hearing Screenings) for the given dates of service. Updated 07/10
Louisiana Medicaid EPSDT Program Fee Schedule on or after July 2012  (PDF Format)

Louisiana Medicaid EPSDT Program Fee Schedule on or after December 2013 (PDF Format)
Fee Schedule for the EPSDT Program (EPSDT Medical, Vision and Hearing Screenings) for the given dates of service.
LT-PCS Procedure Code/Rate Chart Fee Schedule for the Long Term Personal Care Services Program
Mental Health Rehabilitation Fee Schedules Page Fee Schedules for the Mental Health Rehabilitation Program. All CPT codes and descriptions are copyrighted by the American Medical Association.
Multi-Systemic Therapy Fee Schedule Page  Fee Schedules for the Multi-Systemic Therapy Program. All CPT codes and descriptions are copyrighted by the American Medical Association.
Non-Emergency Medical Transportation Fee Schedule  Fee Schedule for Louisiana Non-Emergency Medical Transportation.
OAAS Community Choices Waiver Services/Procedure Codes/Rate Chart  Fee Schedule for the Office of Aging and Adult Services (OAAS) Community Choices Waiver Program
OCDD Procedure Codes/Rates Chart  Procedure Codes/Rates Chart for OCDD
Pediatric Day Health Care Services Fee Schedule   Current Fee Schedule for Pediatric Day Health Care (PDHC).
Professional Services, Laboratory, Radiology, and ASC Fee Schedules   Fee Schedules for HCPCS code, TOS, and as applicable, sex and age restrictions. All CPT codes and descriptions are copyrighted by the American Medical Association. Updated 01/14
Professional Services – ACA Primary Care Services Enhanced Reimbursement Fee Schedule
(effective 1/1/14) (PDF Format)

Professional Services – ACA Primary Care Services Enhanced Reimbursement Fee Schedule
(effective 1/14/14) (Excel Format)
Fee Schedule for Affordable Care Act Primary Care Services effective January 1, 2014. Updated 4/14
Professional Services – ACA Primary Care Services Enhanced Reimbursement Fee Schedule
(effective 2/20/13 – 12/31/13) (PDF Format)
Fee Schedule for Affordable Care Act Primary Care Services effective February 20, 2013. Updated 4/14
Professional Services – ACA Primary Care Services Enhanced Reimbursement Fee Schedule
(effective 1/1/13 – 2/19/13) (PDF Format)
Fee Schedule for Affordable Care Act Primary Care Services effective January 1, 2013. Updated 7/13
Rehabilitation Services Reimbursement Fee Schedules   Fee Schedules for Rehabilitation Services Updated 03/13
RHC Rates Page   Fee schedules for Independent Rural Health Centers and Provider Based Rural Health Centers.
Take Charge Plus Fee Schedule   Fee Schedule for Take Charge Plus Family Planning Program for HCPCS codes and as applicable, sex and age restrictions. All CPT codes and descriptions are copyrighted by the American Medical Association.

Outpatient Hospital Fee Schedules

Outpatient Hospital Ambulatory Surgery Schedules:   
Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural Hospitals (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural Hospitals (Excel Format)
Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Rural Hospitals.
Hospital Outpatient Ambulatory Surgery Fee Schedule for State Hospitals
(effective 8/01/12) (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for State Hospitals
(effective 8/01/12) (Excel Format)
Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for State Hospitals for dates of service 8/01/12 and after.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural and State Hospitals
(effective 2/20/09) (PDF Format)

Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for State Hospitals for dates of service 2/20/09 and prior to 8/1/12.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals
(effective 1/1/14) (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals
(effective 1/1/14) (Excel Format)
Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals for dates of service 1/1/14 and after.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals
(effective 2/01/13) (PDF Format)
Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals for dates of service 2/01/13 and prior to 12/31/13.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals
(effective 8/01/12) (PDF Format)
Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals for dates of service 8/01/12 and prior to 2/1/13.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 1/01/11) (PDF Format) Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals for dates of service 1/01/11 and prior to 8/01/12.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 8/01/10) (PDF Format) Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals for dates of service 8/01/10 and prior to 1/01/11.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 2/03/10) (PDF Format) Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals for dates of service 2/03/10 and prior to 8/01/10.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 8/04/09) (PDF Format) Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals for dates of service 8/04/09 and prior to 2/03/10.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 2/20/09) (PDF Format) Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals, for dates of service 2/20/09 and prior to 8/04/09.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (prior to 2/20/09) (PDF Format) Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Non-Rural and Non-State Hospitals, for dates of service prior to 2/20/09.
Outpatient Hospital Non-Ambulatory Surgery Schedules:    
Hospital Outpatient Services Fee Schedule
(effective 1/1/14) (PDF Format)

Hospital Outpatient Services Fee Schedule
(effective 1/1/14) (Excel Format)
Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 1/1/14 and after.
Hospital Outpatient Services Fee Schedule
(effective 2/1/13) (PDF Format)

Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 2/1/13 and prior to 1/1/14.
Hospital Outpatient Services Fee Schedule
(effective 8/01/12) (PDF Format)

Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 8/01/12 and prior to 2/1/13.
Hospital Outpatient Services Fee Schedule (effective 1/01/11) (PDF Format) Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 1/01/11 and prior to 8/01/12.
Hospital Outpatient Services Fee Schedule (effective 8/01/10) (PDF Format) Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 8/01/10 and prior to 1/01/11. 
Hospital Outpatient Services Fee Schedule (effective 2/03/10) (PDF Format) Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 2/03/10 and prior to 8/01/10.
Hospital Outpatient Services Fee Schedule (effective 8/04/09) (PDF Format) Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 8/04/09 and prior to 2/03/10.
Hospital Outpatient Services Fee Schedule (effective 2/20/09) (PDF Format) Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service 2/20/09 and prior to 8/04/09.
Hospital Outpatient Services Fee Schedule (prior to 2/20/09) (PDF Format) Fee schedule to be utilized by Acute Care Hospitals when billing for outpatient services other than those designated as ambulatory surgery, for dates of service prior to 2/20/09.
Small Rural Hospital Outpatient Services Fee Schedule (effective 1/1/2014) (PDF Format)

Small Rural Hospital Outpatient Services Fee Schedule (effective 1/1/2014) (Excel Format)
Fee schedule to be utilized by Small Rural Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates on and after 1/1/2014.
Small Rural Hospital Outpatient Services Fee Schedule (effective 2/20/2009) Fee schedule to be utilized by Small Rural Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 2/20/09 and prior to 1/1/2014.
Sole Community Hospital Outpatient Services Fee Schedule (effective 1/01/14) (PDF Format)

Sole Community Hospital Outpatient Services Fee Schedule (effective 1/01/14) (Excel Format)
Fee schedule to be utilized by Sole Community Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 1/01/14 and after.
Sole Community Hospital Outpatient Services Fee Schedule (effective 2/20/09) (PDF Format) Fee schedule to be utilized by Sole Community Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 2/20/09 and prior to 1/1/14.
State Hospitals Outpatient Services Fee Schedule
(effective 1/1/14)  (PDF Format)

State Hospitals Outpatient Services Fee Schedule
(effective 1/1/14) (Excel Format)
Fee schedule to be utilized by State Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 1/1/14 and after.
State Hospitals Outpatient Services Fee Schedule
(effective 8/01/12) (PDF Format)
Fee schedule to be utilized by State Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 8/1/12 and prior to 1/1/14.
State Hospitals Outpatient Services Fee Schedule
(effective 2/01/11) (PDF Format)
Fee schedule to be utilized by State Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 2/1/11 and prior to 8/1/12.
State Hospitals Outpatient Services Fee Schedule
(effective 2/20/09) (PDF Format)

Fee schedule to be utilized by State Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 2/20/09 and prior to 2/1/11.
Inpatient Hospital Per Diems  
Inpatient Hospital Per Diem Listing
(effective 7/01/2014) (PDF Format)
Per diem list for in-state inpatient hospitals in effect for dates of service on and after 7/1/2014.
Inpatient Hospital Per Diem Listing
(effective 7/01/2013) (PDF Format)
Per diem list for in-state inpatient hospitals in effect for dates of service 7/1/2013 through 6/30/2014.
Inpatient Hospital Per Diem Listing
(effective 2/01/2013) (PDF Format)
Per diem list for in-state inpatient hospitals in effect for dates of service 2/1/2013 through 6/30/2013.
Out-of-State Inpatient Hospital Per Diem Listing
(effective 9/1/2013) (PDF Format)
Per diem list for out-of-state inpatient hospitals in effect for dates of service on and after 9/1/2013. If a hospital per diem is not on the list, the reimbursement is the default out-of-state rate.