Fee Schedules

Fee Schedules

Applied Behavior Analysis Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Applied Behavior Analysis	01/01/19 PDF	01/01/17 PDF	Select a Date (04/01/14 - 12/31/16)

Anesthesia Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Formula Based Anesthesia Services	Current PDF
Maternity Anesthesia	06/01/15 PDF	02/01/13 PDF	Select a Date (effective 07/01/12) (effective 02/01/12)

Dental Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Adult Denture Program Fee Schedule	07/01/14 PDF	08/01/13 PDF	Select a Date (effective 07/01/12) (effective 11/01/07) (effective 11/01/06) (effective 09/01/04) (effective 08/01/03) (effective 05/01/03) (effective 07/05/02) (effective 01/21/01) (effective 07/01/00) (effective 01/01/95)
EPSDT Dental Program Fee Schedule	07/01/14 PDF	08/01/13 PDF	Select a Date (effective 01/01/13) (effective 07/01/12) (effective 01/01/11) (effective 08/01/10) (effective 01/22/10) (effective 01/01/09) (effective 12/24/08) (effective 11/01/07) (effective 01/01/07) (effective 11/01/06) (effective 11/01/05) (effective 09/01/04) (effective 05/01/03) (effective 07/06/02) (effective 01/21/01) (effective 07/01/00) (effective 01/01/95)

Durable Medical Equipment (DME) Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
DME Enteral Nutrition Fee Schedule	Current PDF
DMEPOS Fee Schedule	01/01/20 PDF, EXCEL	01/01/19 PDF	Select a Date (effective 01/01/18) (effective 01/01/17) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (prior to 01/01/14)

EPSDT Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
EPSDT Medicaid Fee Schedule	Current PDF	07/01/12 PDF
EPSDT Health Services - Provider Type 70	Current PDF	06/30/14 PDF
EPSDT PCS Procedure Code/Rate Chart	07/01/19 PDF	02/09/07 PDF

Home Health Services Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Home Health Services Fee Schedule	01/01/17 PDF	08/01/16 - 12/31/16 PDF	Select a Date (04/01/16 - 07/31/16) (01/01/16 - 03/31/16) (Prior to 12/31/15)
Home Health Revenue and Procedure Codes	11/27/18 PDF

Hospice Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Hospice Rates, CBSA Codes and Revenue Codes	10/01/19 PDF	10/01/18 PDF	Select a Date (effective 10/01/17) (effective 10/01/16) (effective 01/01/16) (effective 10/01/15) (effective 10/01/14) (effective 10/01/13) (effective 10/01/12) (effective 10/01/11)

Immunization Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Children/Adolescents: (Birth through age 18)	01/01/19 PDF	01/01/18 PDF	Select a Date (effective 01/01/17) (effective 05/01/16) (effective 01/01/16) (effective 05/01/15) (effective 01/01/13) (effective 07/01/12) (effective 01/01/11) (effective 08/06/08)
Young Adult: (Ages 19 and 20)	01/01/19 PDF	07/01/18 PDF	Select a Date (effective 01/01/18) (effective 01/01/17) (effective 07/01/16) (effective 05/01/16) (effective 01/01/16) (effective 05/01/15) (effective 07/01/14) (effective 01/01/13) (effective 07/01/12) (effective 08/06/08)
Adult: (Age 21 years and Older)	01/01/19 PDF	07/01/18 PDF	Select a Date (effective 01/01/18) (effective 01/01/17) (effective 07/01/16) (effective 01/01/16) (effective 05/01/15) (effective 07/01/14) (effective 01/01/13) (effective 07/01/12) (effective 08/06/08) prior to 08/05/08

Inpatient Hospital Per Diems	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Inpatient Hospital Per Diem Listing	01/01/20 PDF, EXCEL	07/01/19 PDF, EXCEL	Select a Date (effective 01/01/19) (effective 07/01/18) (effective 01/01/18) (effective 07/01/17) (effective 01/01/17) (effective 07/01/16) (effective 07/01/15) (effective 07/01/14) (effective 07/01/13) (effective 02/01/13)
Out-of-State Inpatient Hospital Per Diem Listing	09/01/2013 PDF

Non-Emergency Medical Transportation (NEMT) Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Public Transit	12/20/11 PDF
Non-Emergency Medical Transportation	10/01/14 PDF	12/01/10 PDF

OAAS Services Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Adult Day Health Care Waiver Services	01/01/19 PDF	04/01/16 PDF	Select a Date (effective 11/07/12) (effective 07/01/12) (effective 07/01/11) (effective 12/01/10) (effective 07/29/10) (effective 08/17/09) (effective 05/13/09) (effective 01/01/09) (effective 09/20/06)
Community Choices Waiver Services	01/01/19 PDF	04/01/17 PDF	Select a Date (effective 01/01/17) (effective 04/01/16) (effective 11/06/15) (effective 07/27/15) (effective 06/16/15) (effective 10/29/13) (effective 10/01/12) (effective 05/21/12) (effective 04/23/12) (effective 12/20/11) (effective 11/04/11) (effective 10/01/11)
Long Term-Personal Care Services	01/01/19 PDF	07/22/12 PDF	Select a Date (effective 07/01/12) (effective 01/01/12) (effective 01/12/12) (effective 07/22/12) (effective 08/01/11) (effective 01/01/11) (effective 12/01/10) (effective 08/01/10) (effective 08/04/09) (effective 02/09/07)

OCDD Services Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Children's Choice Waiver	01/09/19 PDF	06/29/16 PDF	Select a Date (effective 06/30/14) (effective 06/23/14) (effective 05/24/14) (effective 04/25/13) (effective 04/01/11)
EPSDT Early Intervention Services (EarlySteps)	07/01/18 PDF	01/01/17 PDF	Select a Date (effective 01/01/14) (effective 01/01/11) (effective 09/01/08) (effective 02/01/05) (effective 07/07/03)
New Opportunities Waiver	09/01/19 PDF	06/29/16 PDF	Select a Date (effective 06/30/14) (effective 05/30/14) (effective 05/22/14) (effective 03/01/11)
Residential Options Waiver	01/23/19 PDF	01/20/17 PDF	Select a Date (effective 06/29/16) (effective 12/01/11)
Supports Waiver	09/01/19 PDF	02/25/14 PDF	Select a Date (effective 02/25/14) (effective 06/10/11)

Other Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Ambulance Fee Schedule	08/01/12 PDF	06/30/12 PDF
American Indians 638 Facilities Rates (Provider Type 95) :	01/01/19 PDF	01/01/18 PDF	Select a Date (effective 01/01/17)
Federally Qualified Health Centers (FQHCs) Rates (Provider Type 72)	07/01/19 PDF, EXCEL	04/01/19 PDF	Select a Date (effective 07/01/18) (effective 07/01/17) (effective 07/01/16) (effective 04/22/15) (effective 07/24/14) (effective 07/16/13) (effective 09/18/12) (effective 06/30/11)
Independent Rural Health Clinics (I-RHCs) Rates (Provider Type 87)	07/01/19 PDF, EXCEL	04/01/19 PDF	Select a Date (effective 07/01/18) (effective 07/01/17) (effective 07/01/16) (effective 07/30/14) (effective 06/23/14) (effective 07/18/13) (effective 06/30/12) (effective 06/30/11)
Provider Based Rural Health Clinics (PB-RHCs) Rates (Provider Type 79)	07/01/19 PDF, EXCEL	04/01/19 PDF	Select a Date (effective 07/01/18) (effective 07/01/17) (effective 07/01/16) (effective 03/11/15) (effective 06/30/14) (effective 06/18/13) (effective 09/19/12) (effective 06/30/11)
OPH – Family Planning Clinic (Provider Type 71) :	01/01/18 PDF	02/01/13 PDF

Outpatient Hospital Ambulatory Surgery	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Rural: TOS (15)	01/01/20 PDF, EXCEL	01/01/19 PDF	Select a Date (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 01/01/16) (effective 01/01/15) (effective 08/01/12) (effective 02/20/09)
State: TOS (15)	01/01/20 PDF, EXCEL	01/01/19 PDF	Select a Date (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 01/01/16) (effective 01/01/15) (effective 08/01/12) (effective 02/20/09)
Non-Rural, Non-State: TOS (15)	01/01/20 PDF, EXCEL	01/01/19 PDF	Select a Date (effective 01/01/18) (effective 01/01/17) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 02/01/13) (effective 08/01/12) (effective 01/01/11) (effective 08/01/10) (effective 02/03/10) (effective 08/04/09) (effective 02/20/09) (prior to 02/20/09)

Outpatient Hospital Services	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Acute Care Hospital: TOS (30)	01/01/20 PDF, EXCEL	07/01/19 PDF	Select a Date (effective 01/01/19) (effective 02/01/18) (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 07/01/16) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 02/01/13) (effective 08/01/12) (effective 01/11/11) (effective 08/01/10) (effective 02/03/10) (effective 08/04/09) (effective 02/20/09) prior to 02/20/09
Small Rural Hospital: TOS (37)	01/01/20 PDF, EXCEL	07/01/19 PDF	Select a Date (effective 01/01/19) (effective 02/01/18) (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 07/01/16) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 02/20/09)
State Hospital: TOS (39)	01/01/20 PDF, EXCEL	07/01/19 PDF	Select a Date (effective 01/01/18) (effective 02/01/18) (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 07/01/16) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 08/01/12) (effective 02/01/11) (effective 02/20/09)
Sole Community Hospital: TOS (40)	01/01/20 PDF, EXCEL	07/01/19 PDF	Select a Date (effective 01/01/19) (effective 02/01/18) (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 07/01/16) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 02/20/09)

Pediatric Day Health Care Services Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Pediatric Day Health Care Services Fee Schedule	09/01/16 PDF	07/01/12 PDF

Professional Services, Lab, X-Ray, Radiology and ASC	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Professional:	01/01/20 PDF, EXCEL	01/01/19 PDF	Select a Date (effective 07/01/18) (effective 02/01/18) (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 07/01/16) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 08/20/13) (effective 02/20/13) (effective 01/01/13) (effective 07/01/12) (effective 01/01/12) (effective 01/01/11) (effective 12/01/10) (effective 08/01/10) (effective 01/22/10) (effective 08/04/09) (effective 02/26/09) (effective 01/01/09) (effective 01/01/08) (effective 10/15/07) (effective 10/14/07)
Laboratory & Radiology: (Non-Hospital)	01/01/20 PDF, EXCEL	11/01/19 PDF	Select a Date (effective 07/01/19 (effective 01/01/19 (effective 02/01/18 (effective 01/01/18 (effective 01/01/17 (effective 07/01/16) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 02/01/13) (effective 01/01/13) (effective 07/01/12) (effective 01/01/12) (effective 01/01/11) (effective 08/01/10) (effective 01/22/10) (effective 08/04/09) (effective 02/26/09) (effective 01/01/09) (effective 01/01/08) (effective 10/15/07) (effective 10/14/07)
Portable Radiology/EKG (Non-Hospital)	01/01/18 PDF, EXCEL	01/01/16 PDF
Ambulatory Surgical Center (Non-Hospital TOS 08)	01/01/20 PDF, EXCEL	01/01/19 PDF	Select a Date (effective 01/01/18) (effective 01/01/17) (effective 10/01/16) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14) (effective 02/01/13) (effective 01/01/13) (effective 07/01/12) (effective 01/01/12) (effective 01/01/11) (effective 08/01/10) (effective 02/05/10) (effective 02/26/09) (effective 01/01/09) (effective 01/01/08) (effective 10/15/07) (effective 10/14/07)

Rehabilitation Services Reimbursement Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Free Standing Rehabilitation Centers Fee Schedule	01/01/18 PDF, EXCEL	01/01/17 PDF	Select a Date (effective 01/01/16) (effective 01/01/14) (effective 11/01/12)

Specialized Behavioral Health Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Specialized Behavioral Health	01/01/20 PDF, EXCEL	08/01/19 PDF	Select a Date (effective 01/01/19) (effective 07/01/18) (effective 01/01/18) (effective 12/01/15)

Take Charge Plus Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Take Charge Plus Fee Schedule	01/01/20 PDF, EXCEL	01/01/19 PDF	Select a Date (effective 07/01/18) (effective 01/01/18) (effective 01/01/17) (effective 01/01/16) (effective 01/01/15) (effective 01/01/14)

Vision (Eye-wear) Fee Schedule	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
Vision (Eye-wear) Fee Schedule	06/01/18 PDF	07/01/12 PDF

LSU Enhanced Professional Services Fee Schedules	Current Schedule Effective Date	Previous Schedule Effective Date	Archives
LSU Shreveport Enhanced Professional Services Fee Schedule	01/01/20 PDF, EXCEL
LSU New Orleans Enhanced Professional Services Fee Schedule	01/01/20 PDF, EXCEL
LSU Enhanced Formula Based Anesthesia Fee Schedule	01/01/20 PDF
LSU Enhanced Maternity Anesthesia Fee Schedule	01/01/20 PDF

Obsolete Fee Schedules	Archived Dates
ACA: (Age 0 through age 18)	Select a Date (effective 1/1/14) (effective 1/1/13)
ACA: (Age 19 and Older)	Select a Date (effective 1/1/14) (effective 1/1/13)
EDSPW Dental Program Fee Schedule	Select a Date (effective 07/01/12) (effective 07/01/11) (effective 08/01/10) (effective 01/22/10) (effective 01/06/09) (effective 11/01/07) (effective 11/01/06) (effective 11/01/05) (effective 09/01/04) (effective 11/01/03)
EPSDT Psychological and Behavioral Services Fee Schedule	Select a Date 12/08/06
Greater New Orleans Community Health Connection	Select a Date 01/01/14 10/01/11
H1N1: Professional Services	Select a Date (effective 09/15/10)
H1N1: Outpatient Hospitals & ESRD	Select a Date (effective 09/15/10)
KIDMED Program Fee Schedule	Select a Date (effective 01/22/10) (effective 10/15/07)
Multi-Systemic Therapy Fee Schedule	Select a Date (effective 01/01/11) (effective 08/01/10) (effective 01/22/10) (effective 08/04/09) (effective 07/01/08)
Rehabilitation Services Schedule	Select a Date 07/01/12 05/30/12