Fee Schedules
The following list consists of Fee Schedules used by Louisiana Medicaid providers.
| Fee Schedules | Description |
| Ambulance Fee Schedule (PDF Format) | Fee Schedule for Louisiana Medicaid Ambulance Transportation effective 9/1/2006. |
| Dental Fee Schedule Listings | Fee Schedules for Adult Denture, EPSDT, and Expanded Dental Services for Pregnant Women (EDSPW) programs for given dates of service. |
| DMEPOS Fee Schedule (PDF Format) | Fee Schedule for the Louisiana Medicaid DMEPOS Program |
| EDA Services/Procedure Codes/Rate Chart (PDF Format) |
Elderly and
Disabled Adult (EDA) Waiver Procedure code chart that identifies the
necessary billing information for Waiver EDA providers that becomes
effective July 1, 2006. Updated 08/07 |
| EPSDT Early Intervention Services (EarlySteps) Fee Schedule for Dates of Service July 7, 2003 - January 31, 2005 (PDF Format) | Fee Schedule for the Louisiana Medicaid Early Steps Program for the given dates of service. |
| EPSDT Early Intervention Services (EarlySteps) Fee Schedule for Dates of Service February 1, 2005 – August 31, 2008 (PDF Format) | Fee Schedule for the Louisiana Medicaid Early Steps Program for the given dates of service. |
| EPSDT Early Intervention Services (Early Steps) Fee Schedule for Dates of Service September 1, 2008 and forward (PDF Format) | *Current* Fee Schedule for the Louisiana Medicaid Early Steps Program for the given dates of service. |
| 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. |
| Home Health Services Fee Schedule (PDF Format) | Current Fee Schedule for Home Health Services. Added 06/09 |
| 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 |
| LT-PCS Procedure Code/Rate Chart (PDF Format) | Long Term-Personal Care Services (LT-PCS) procedure code chart that identifies the necessary billing information for Waiver LT-PCS providers. Updated 10/07 |
| 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. |
| 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 06/10 |
Outpatient Hospital Fee Schedules
| Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural and State Hospitals (PDF Format) | Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Rural and State Hospitals. |
| 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. |
| 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 (effective 8/4/09) (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 2/3/10) (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 after. |
| 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. |
| 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 (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 2/03/10) (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 after. |
| Small Rural Hospital Outpatient Services Fee Schedule (PDF 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) | 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 (PDF Format) | Fee schedule to be utilized by State Hospitals when billing for outpatient services except those designated as ambulatory surgery. |