Medicaid Provider Manuals

COVID-19 Update: Changes to Medicaid policy and procedure deemed of an imminent peril to the public health, safety, or welfare and requiring immediate approval, such as those related to COVID-19, are exempt from the legislative requirement to publish the proposed policy or procedure for public comment prior to implementation. To keep abreast of these exempted changes to policy and procedure related to COVID-19, refer to the Coronavirus (COVID-19) Medicaid Information website, which provides guidance to Medicaid providers and managed care organizations, emergency rules, and requests LDH has submitted to the Centers for Medicare & Medicaid Services (CMS). Broader information related to COVID-19 can be found at http://ldh.la.gov/Coronavirus/.


The intent of the provider services manual is to present useful information and guidance to providers participating in the Louisiana Medicaid Program. The first chapter, "General Information and Administration" contains information applicable to all providers. Each remaining chapter is dedicated to a specific program or service and outlines the policies, procedures, qualifications, services and limitations to that service or program.Click here to view current provider manuals.

Below are the changes to provider manuals beginning August 1, 2019.To provide feedback, please complete this form.

Item Number Provider Manual Chapter Date Posted Public Comments Due By Document Links
2021- Behavioral Health Services – 2

Section 2.5 - CSoC

4/7/21 5/23/21 Section 2.5 - CSoC
2021- Behavioral Health Services – 1

Appendix D – Approved Curriculum Equiv.

4/7/21 5/23/21 Appendix D – Approved Curriculum Equiv.
2021-Dental Services – 16

Appendix J – Contact Referral Information

3/31/21 5/15/21 Appendix J – Contact Referral Information
2021-Dental Services – 15 Appendix F – Claim Denial Simplification Process 3/31/21 5/15/21 Appendix F – Claim Denial Simplification Process
2021-Dental Services – 14 Appendix D – Adjustment-Void Forms and Instructions 3/31/21 5/15/21 Appendix D – Adjustment-Void Forms and Instructions
2021-Dental Services – 13 Appendix C – Dental Claim Form Instructions 3/31/21 5/15/21 Appendix C – Dental Claim Form Instructions
2021-Dental Services – 12 Appendix B – Adult Denture Fee Schedule 3/31/21 5/15/21 Appendix B – Adult Denture Fee Schedule
2021-Dental Services – 11 Appendix A – EPSDT Fee Schedule 3/31/21 5/15/21 Appendix A – EPSDT Fee Schedule
2021-Dental Services – 10 Section 16.11 – Adult Denture – Prior Authorization 3/31/21 5/15/21 Section 16.11 – Adult Denture – Prior Authorization
2021-Dental Services – 9 Section 16.9 – Adult Denture – Covered Services 3/31/21 5/15/21 Section 16.9 – Adult Denture – Covered Services
2021-Dental Services – 8 Section 16.8 – Adult Denture – Beneficiary Eligibility 3/31/21 5/15/21 Section 16.8 – Adult Denture – Beneficiary Eligibility
2021-Dental Services – 7 Section 16.7 – EPSDT - Prior Authorization 3/31/21 5/15/21 Section 16.7 – EPSDT - Prior Authorization
2021-Dental Services – 6 Section 16.5 – EPSDT - Covered Services 3/31/21 5/15/21 Section 16.5 – EPSDT - Covered Services
2021-Dental Services – 5 Section 16.4 – EPSDT - Securing Services 3/31/21 5/15/21 Section 16.4 – EPSDT - Securing Services
2021-Dental Services – 4 Section 16.3 – EPSDT - Beneficiary Eligibility 3/31/21 5/15/21 Section 16.3 – EPSDT - Beneficiary Eligibility
2021-Dental Services – 3 Section 16.2 – Claims Related Information 3/31/21 5/15/21 Section 16.2 – Claims Related Information
2021-Dental Services – 2 Section 16.1 – Provider Requirements 3/31/21 5/15/21 Section 16.1 – Provider Requirements
2021-Dental Services – 1 Section 16.0 – Overview 3/31/21 5/15/21 Section 16.0 – Overview
2021-Professional Services – 7 Section 5.1 – Covered Services - Obstetrics 3/16/21 4/29/21 Section 5.1 – Covered Services - Obstetrics
2021-Pharmacy – 1 Section 37.1 – Covered Services 3/10/21 4/23/21 Section 37.1 – Covered Services
2021-Professional Services – 1 Section 5.1 – Covered Services – ‘Incident To’ Services 2/22/21 4/7/21 Section 5.1 – Covered Services – ‘Incident To’ Services
2021-Professional Services – 2 Section 5.1 – Covered Services – Physician’s Assistant 2/22/21 4/7/21 Section 5.1 – Covered Services – Physician’s Assistant
2021-Professional Services – 3 Section 5.1 – Covered Services – Preventative Medicine Evaluation 2/22/21 4/7/21 Section 5.1 – Covered Services – Preventative Medicine Evaluation
2021-Professional Services – 4 Section 5.1 – Covered Services – Prior Authorization 2/22/21 4/7/21 Section 5.1 – Covered Services – Prior Authorization
2021-Professional Services – 5

Section 5.1 – Covered Services – Professional Fee Schedule

2/22/21 4/7/21 Section 5.1 – Covered Services – Professional Fee Schedule
2021-Professional Services – 6

Section 5.1 – Covered Services – Prohibited and Non-Covered Services

2/22/21 4/7/21 Section 5.1 – Covered Services – Prohibited and Non-Covered Services
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