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 |
| 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 (PDF Format) | 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 12/10 |
| 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) |
| 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 1, 2012 (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 effective August 1, 2010. |
| OAAS Community Choices Waiver Services/Procedure Codes/Rate Chart | Fee Schedule for the Office of Aging and Adult Services (OAAS) Community Choices Waiver Program |
| 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 10/10 |
| 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. RehabilitationfServ_FS.htm |
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 2/1/13) (PDF Format) Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 2/1/13) (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 2/1/13 and after. |
|
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 2/1/13) (PDF Format) Hospital Outpatient Services Fee Schedule (effective 2/1/13) (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 2/1/13 and after. |
|
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 (PDF Format) Small Rural Hospital Outpatient Services Fee Schedule (Excel Format) |
Fee schedule to be utilized by Small Rural Hospitals when billing for outpatient services except those designated as ambulatory surgery. |
| Sole Community Hospital
Outpatient Services Fee Schedule (PDF Format) Sole Community Hospital Outpatient Services Fee Schedule (Excel Format) |
Fee schedule to be utilized by Sole Community Hospitals when billing for outpatient services except those designated as ambulatory surgery. |
| State Hospitals Outpatient Services Fee Schedule (effective 8/01/12) (PDF Format) State Hospitals Outpatient Services Fee Schedule (effective 8/01/12) (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 8/1/12 and after. |
| 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 2/01/2013) (PDF Format) |
Per diem list for in-state inpatient hospitals in effect for dates of service on and after 2/1/2013. |