Fee Schedules

Fee Schedules Provider Manuals Provider Forms Policy Home

 

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.
EPSDT Health Services Fee Schedule   Fee schedule for EPSDT Health Services

EPSDT Medicaid Fee Schedule (Current) (PDF Format)

EPSDT Medicaid Fee Schedule (Previous) (PDF Format)

  Fee schedule for the EPSDT Program (EPSDT Medical, Vision and Hearing Screenings) for the given dates of service.
EPSDT PCS Procedure Code/Rate Chart (PDF Format)   Fee schedule for EPSDT Personal Care Services.
EPSDT Psychological and Behavioral Services Fee Schedule for Dates of Service (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.
Home Health Services Fee Schedule (PDF Format)   Current Fee Schedule for Home Health Services
Hospice Rates   Hospice Rates, MSA Codes and Revenue Codes for Louisiana Hospice Program

Immunization Fee Schedules

Birth - 18 years

19 - 20 years

21 years and older

  Fee schedules for Immunizations of:
- Children/Adolescents (birth through 18 years);
- 19 & 20 year old enrollees;
- Adults (age 21 years and older)
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.
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 and Radiology

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.
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 (PDF Format)

Take Charge Plus Fee Schedule (Excel Format)

  Fee schedule for Take Charge Plus Family Planning Program for HCPCS codes and as applicable, sex and age restrictions, for dates of service. All CPT codes and descriptions are copyrighted by the American Medical Association.
Take Charge Plus Fee Schedule (effective 1/1/16)   Fee schedule for Take Charge Plus Family Planning Program for HCPCS codes and as applicable, sex and age restrictions, for dates of service January 1, 2016 through December 31, 2016.
Take Charge Plus Fee Schedule (effective 1/1/15)   Fee schedule for Take Charge Plus Family Planning Program for HCPCS codes and as applicable, sex and age restrictions, for dates of service January 1, 2015 through December 31, 2015.
Take Charge Plus Fee Schedule (effective 1/1/14)   Fee schedule for Take Charge Plus Family Planning Program for HCPCS codes and as applicable, sex and age restrictions, for dates of service July 1, 2014 through December 31, 2014.

 

 

Outpatient Hospital Fee Schedules

Outpatient Hospital ambulatory surgery schedules    
Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural Hospitals (effective 1/1/16) (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural Hospitals (effective 1/1/16) (Excel Format)
  Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Rural Hospitals for dates of service 1/1/2016 and after.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural Hospitals (effective 1/1/15) (PDF Format)   Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Rural Hospitals for dates of service 1/1/15 and prior to 12/31/15.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Rural Hospitals (effective 8/1/12) (PDF Format)   Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for Rural Hospitals for dates of service 8/1/12 and prior to 1/15/15.
Hospital Outpatient Ambulatory Surgery Fee Schedule for State Hospitals
(effective 1/1/16) (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for State Hospitals
(effective 1/1/16) (Excel Format)
  Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for State Hospitals for dates of service 1/1/16 and after.
Hospital Outpatient Ambulatory Surgery Fee Schedule for State Hospitals (effective 1/1/15) (PDF Format)   Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for State Hospitals for dates of service 1/1/15 and prior to 12/31/15
Hospital Outpatient Ambulatory Surgery Fee Schedule for State Hospitals
(effective 8/1/12) (PDF Format)
  Fee schedule for Hospital Outpatient Ambulatory Surgery Codes, with applicable sex and age restrictions, for State Hospitals for dates of service 8/1/12 and prior to 1/15/2015.
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 1/1/16) (PDF Format)

Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 1/1/16) (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 1/1/16 and after.
Hospital Outpatient Ambulatory Surgery Fee Schedule for Non-Rural, Non-State Hospitals (effective 1/1/15) (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 1/1/15 and prior to 1/1/16.
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 prior to 1/1/15.
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 2/1/13 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 8/1/12 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 1/1/11 and prior to 8/1/12.
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 8/1/10 and prior to 1/1/11.
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 2/3/10 and prior to 8/1/10.
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 8/4/09 and prior to 2/3/10.
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 8/4/09.
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 1/1/16) (PDF Format)

Hospital Outpatient Services Fee Schedule(effective 1/1/16) (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 1/1/16 and after.
Hospital Outpatient Services Fee Schedule (effective 1/1/15) (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 1/1/15 and prior to 1/1/16.
Hospital Outpatient Services Fee Schedule (effective 1/1/14) (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 1/1/14 and prior to1/1/15.

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 8/1/12) (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 8/1/12 and prior to 2/1/13.
Hospital Outpatient Services Fee Schedule(effective 1/1/11) (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 1/1/11 and prior to 8/1/12.
Hospital Outpatient Services Fee Schedule(effective 8/1/10) (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 2/3/10) (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 2/3/10 and prior to 8/1/10.
Hospital Outpatient Services Fee Schedule(effective 8/4/09) (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 8/4/09 and prior to 2/3/10.
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 8/4/09.
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 1/1/2016) (PDF Format)

Small Rural Hospital Outpatient Services Fee Schedule (effective 1/1/2016) (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 1/1/2016.
Small Rural Hospital Outpatient Services Fee Schedule (effective 1/1/2015) (PDF Format)   Fee schedule to be utilized by Small Rural Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 1/1/2015 and prior to 12/31/2015.
Small Rural Hospital Outpatient Services Fee Schedule (effective 1/1/2014) (PDF Format)   Fee schedule to be utilized by Small Rural Hospitals when billing for outpatient services except those designated as ambulatory surgery for dates of service 1/1/2014 and prior to 1/1/2015.
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 1/1/16) (PDF Format)

Sole Community Hospital Outpatient Services Fee Schedule (effective 1/1/16) (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 1/1/16 and after
Sole Community Hospital Outpatient Services Fee Schedule (effective 1/1/15) (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 1/1/14 and prior to 12/31/14.
Sole Community Hospital Outpatient Services Fee Schedule (effective 1/1/14) (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 1/1/14 and prior to 12/31/14.
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 1/1/16)  (PDF Format)

State Hospitals Outpatient Services Fee Schedule (effective 1/1/16) (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 1/1/16 and after.
State Hospitals Outpatient Services Fee Schedule (effective 1/1/15)  (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 1/1/15 and prior to 1/1/16.
State Hospitals Outpatient Services Fee Schedule (effective 1/1/14)  (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 1/1/14 and prior to 1/1/15.
State Hospitals Outpatient Services Fee Schedule (effective 8/1/12) (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 2/1/11) (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 7/1/2015) (PDF Format)   Per diem list for in-state inpatient hospitals in effect for dates of service on and after 7/1/2015.
Inpatient Hospital Per Diem Listing (effective 7/1/2014) (PDF Format)   Per diem list for in-state inpatient hospitals in effect for dates of service 7/1/2014 through 6/30/2015.
Inpatient Hospital Per Diem Listing (effective 7/1/2013) (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 2/1/2013) (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.