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.
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
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 (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
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.
Non-Emergency Medical Transportation Fee Schedule  Fee Schedule for Louisiana Non-Emergency Medical Transportation effective August 1, 2010.
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
RHC PPS Rates Page   Fee schedules for Independent Rural Health Centers and Provider Based Rural Health Centers.

Outpatient Hospital Fee Schedules

Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural and State Hospitals (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural and State Hospitals (Excel 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 (effective 1/01/11) (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 1/01/11) (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 1/01/11 and after.
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.
Hospital Outpatient Services Fee Schedule (effective 1/01/11) (PDF Format)

Hospital Outpatient Services Fee Schedule (effective 1/01/11) (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 1/01/11 and after.
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 (PDF Format)

State Hospitals Outpatient Services Fee Schedule (Excel Format) 		Fee schedule to be utilized by State Hospitals when billing for outpatient services except those designated as ambulatory surgery.