Medicaid Provider Manuals Archive (2019-2021)

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 items previously posted for public comment:

Item Number Provider Manual Chapter Date Posted Comment Period Closed Document Links
2021 – Professional Services - 24

Section 5.1 – Sinus Procedures

12/15/21 1/29/22 Section 5.1 – Sinus Procedures
2021-PBMS-1

Section 37.1 - Covered Services, Exclusions, and Limitations

12/13/21 1/27/22 Section 37.1 - Covered Services, Exclusions, and Limitations
 2021-BH-16

Section 2.3 – Outpatient Services

12/2/21  1/16/22   Section 2.3 – Outpatient Services
2021-ROW-10

Section 38.8 – Record Keeping

 11/17/21 1/1/22  Section 38.8 – Record Keeping
2021-DME-6

Section 18.2 – Specific Coverage Criteria

11/16/21 12/31/21 Section 18.2 – Specific Coverage Criteria
2021-BH-15

Section 2.4 – Addiction - OTP

11/5/21 12/20/21 Section 2.4 – Addiction - OTP
2021 – ROW - 9

Appendix B – Glossary

11/3/21 12/18/21 Appendix B – Glossary
2021 – ROW -8

Section 38.11 – Incidents, Accidents and Complaints

11/3/21 12/18/21 Section 38.11 – Incidents, Accidents and Complaints
2021 – ROW -7

Section 38.10 – Program Monitoring

11/3/21 12/18/21 Section 38.10 – Program Monitoring
2021 – ROW -6

Section 38.9 – Reimbursement –Monitoring.  

11/3/21 12/18/21 Section 38.9 – Reimbursement –Monitoring.  
2021 – ROW -5

Section 38.7 – Staffing Requirements

11/3/21 12/18/21 Section 38.7 – Staffing Requirements
2021 – ROW -4

Section 38.5 – Service Access and Authorization

11/3/21 12/18/21 Section 38.5 – Service Access and Authorization
2021 – ROW -3

Section 38.4 – Rights and Responsibilities

11/3/21 12/18/21 Section 38.4 – Rights and Responsibilities
2021-Professional Services-23 Section 5.1 -  Covered Services – Cardiovascular 10/29/21 12/13/21 Section 5.1 -  Covered Services – Cardiovascular
2021-Medical Transportation-6 Section 10.8 – Emergency Ambulance Transportation 10/22/21 12/6/21 Section 10.8 – Emergency Ambulance Transportation
2021-Medical Transportation-7 Section 10.13 – Ambulance – Claims and Encounters 10/22/21 12/6/21 Section 10.13 – Ambulance – Claims and Encounters
2021-ROW-2 Section 38.3 – Beneficiary Requirements 10/20/21 12/4/21 Section 38.3 – Beneficiary Requirements
2021-BH-11 Section 2.2 – Bed Based Services – Crisis Stabilization for Adults 9/27/21 11/11/21 Section 2.2 – Bed Based Services – Crisis Stabilization for Adults
2021-BH-12 Section 2.3 – Outpatient Services – Crisis Response Services for Adults 9/27/21 11/11/21 Section 2.3 – Outpatient Services – Crisis Response Services for Adults
2021-BH-13 Appendix B – Glossary/Acronyms 9/27/21 11/11/21 Appendix B – Glossary/Acronyms
2021-BH-14 Appendix D – Approved Curriculum Equivalency 9/27/21 11/11/21 Appendix D – Approved Curriculum Equivalency
2021-Medical Transportation-1 Section 10.1 – Covered Services 9/24/21 11/8/21 Section 10.1 – Covered Services
2021-Medical Transportation-2 Section 10.2 – Scheduling and Authorization 9/24/21 11/8/21 Section 10.2 – Scheduling and Authorization
2021-Medical Transportation-3 Section 10.3 – Provider Requirements 9/24/21 11/8/21 Section 10.3 – Provider Requirements
2021-Medical Transportation-4 Section 10.4 – Provider Responsibilities   9/24/21 11/8/21 Section 10.4 – Provider Responsibilities
2021-Medical Transportation-5 Section 10.6 – Claims and Encounters 9/24/21 11/8/21 Section 10.6 – Claims and Encounters
2021 – Professional Services -22 Section 5.1 – Covered Services - Cardiology 9/14/21 10/29/21 Section 5.1 – Covered Services - Cardiology
2021-Professional Services-21 Section 5.1 - Covered Services - Cochlear Implants 9/9/21 10/24/21 Section 5.1 - Covered Services - Cochlear Implants
2021-Hospitals-1 Section 25.6 - Prior Authorization 9/9/21 10/24/21 Section 25.6 - Prior Authorization
2021-Professional Services-20 Section 5.1 – Covered Services – Anesthesia 9/7/21 10/22/21 Section 5.1 – Covered Services – Anesthesia
2021-DME-5 Section 18.2 – Specific Coverage Criteria 9/7/21 10/22/21 Section 18.2 – Specific Coverage Criteria
2021-RHC-2 Section 40.1 – Covered Services 8/13/21 9/26/21 Section 40.1 – Covered Services
2021-FQHC-2 Section 22.1 – Covered Services 8/13/21 9/26/21 Section 22.1 – Covered Services
2021-RHC-1 Section 40.4 - Reimbursement 8/10/21 9/23/21 Section 40.4 - Reimbursement
2021-FQHC-1 Section 22.4 - Reimbursement 8/10/21 9/23/21 Section 22.4 - Reimbursement 
2021-Professional Services-19

Section 5.1 – Covered Services - EPSDT

8/10/21  9/23/21 Section 5.1 – Covered Services - EPSDT  
2021-Professional Services-18

Section 5.1 – Covered Services – Skin Substitutes

 8/3/21 9/16/21  Section 5.1 – Covered Services – Skin Substitutes
2021-NOW-4

Section 32.8 - Record Keeping

7/27/21 9/10/21 Section 32.8 - Record Keeping
2021-Professional Services-17

Section 5.1 – Genetic Testing

7/26/21 9/9/21 Section 5.1 – Genetic Testing
2021-NOW-1 Section 32.1 – Covered Services 7/15/21 8/29/21 Section 32.1 – Covered Services
2021-NOW-2 Section 32.5 – Service Access and Authorization 7/15/21 8/29/21 Section 32.5 – Service Access and Authorization
2021-NOW-3 Section 32.6 – Provider Requirements 7/15/21 8/29/21 Section 32.6 – Provider Requirements
2021-BHS-1 Section 2.3 – Outpatient Services – Outpatient Therapy by Licensed Practitioners 7/7/21 8/21/21 Section 2.3 – Outpatient Services – Outpatient Therapy by Licensed Practitioners
2021- ROW Services - 1 Section 38.0 – Overview 6/23/21 8/6/21 Section 38.0 – Overview
2021-Pharmacy Benefits Management Services - 1 Section 37.1 – Covered Services 6/22/21 8/5/21 Section 37.1 – Covered Services
2021-PACE-5 Section 35.1 – Services 6/14/21 7/29/21 Section 35.1 – Services
2021-PACE-6

Section 35.2 – Beneficiary Requirements

6/14/21

7/29/21

Section 35.2 – Beneficiary Requirements
2021-PACE-7

Section 35.3 – Service Access and Authorization

6/14/21 7/29/21 Section 35.3 – Service Access and Authorization
2021-PACE-8 Section 35.4 – Provider Requirements 6/14/21 7/29/21 Section 35.4 – Provider Requirements
2021-PACE-9

Section 35.7 – Reimbursement

6/14/21 7/29/21 Section 35.7 – Reimbursement
2021-PACE-10

Section 35.X – Beneficiary Rights and Responsibilities

6/14/21 7/29/21 Section 35.X – Beneficiary Rights and Responsibilities
2021-PACE-11

Appendix A - Glossary

6/14/21 7/29/21 Appendix A - Glossary
2021-Professional Services-7 Section 5.0 – Overview 5/20/21 7/3/21 Section 5.0 – Overview
2021-Professional Services-8

Section 5.1 – Critical Care Services

5/20/21 7/3/21 Section 5.1 – Critical Care Services
2021-Professional Services-9

Section 5.1 – Global Surgery Period

5/20/21 7/3/21 Section 5.1 – Global Surgery Period
2021-Professional Services-10

Section 5.1 – Gynecology

5/20/21 7/3/21 Section 5.1 – Gynecology
2021-Professional Services-11 Section 5.1 – Medical Review 5/20/21 7/3/21 Section 5.1 – Medical Review
2021-Professional Services-12 Section 5.1 – Modifiers 5/20/21 7/3/21 Section 5.1 – Modifiers
2021-Professional Services-13 Section 5.1 - Obstetrics 5/20/21 7/3/21 Section 5.1 - Obstetrics
2021-Professional Services-14 Section 5.1 – Physician Administered Drugs 5/20/21 7/3/21 Section 5.1 – Physician Administered Drugs
2021-Professional Services-15

Section 5.1 – Sterilizations

5/20/21 7/3/21 Section 5.1 – Sterilizations
2021-PBMS-1

Section 35.5.11- Medication Administration

4/29/21 6/12/21 Section 35.5.11- Medication Administration
2021-Hospice-2

Section 24.3 – Covered Service

4/26/21 6/9/21 Section 24.3 – Covered Service
2021-Hospice–1

Section 24.2 – Election of Hospice

4/26/21 6/9/21 Section 24.2 – Election of Hospice
2021-PACE-4

Section 35.10 – Grievances/Complaints

4/21/21 6/4/21 Section 35.10 – Grievances/Complaints
2021-PACE-3

Section 35.9 – Program Quality and Oversight

4/21/21 6/4/21 Section 35.9 – Program Quality and Oversight
2021-PACE-2

Section 35.6 – Record Keeping  

4/21/21 6/4/21 Section 35.6 – Record Keeping  
2021-PACE-1

Section 35.0 – Overview

4/21/21 6/4/21 Section 35.0 – Overview
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
2021-GIA-1

General Information and Administration -

Section 1.4 – General Claims Filing

 2/9/21 3/25/21 General Information and Administration - Section 1.4 – General Claims Filing
2020-EPSDT Health-1

EPSDT Health + Idea - Section 20.0 – Overview

 12/28/20 2/11/21  EPSDT Health + Idea - Section 20.0 – Overview
2020-EPSDT Health-2

EPSDT Health + Idea - Section 20.1 – Covered Services

12/28/20  2/11/21  EPSDT Health + Idea - Section 20.1 – Covered Services
2020-EPSDT Health-3

EPSDT Health + Idea - Section 20.2 – Eligibility Criteria

12/28/20  2/11/21  EPSDT Health + Idea - Section 20.2 – Eligibility Criteria
2020-EPSDT Health-4

EPSDT Health + Idea - Section 20.3 – Provider Requirements

12/28/20  2/11/21  EPSDT Health + Idea - Section 20.3 – Provider Requirements
2020-EPSDT Health-5

EPSDT Health + Idea - Section 20.4 – Program Requirements

12/28/20  2/11/21  EPSDT Health + Idea - Section 20.4 – Program Requirements
2020-EPSDT Health-6

EPSDT Health + Idea - Section 20.5 – Record Keeping

12/28/20  2/11/21  EPSDT Health + Idea - Section 20.5 – Record Keeping
2020-EPSDT Health-7 

EPSDT Health + Idea - Section 20.6 – Reimbursement

12/28/20  2/11/21  EPSDT Health + Idea - Section 20.6 – Reimbursement
2020-Behavioral Health-10

Behavioral Health Services - Section 2.3 – Outpatient Services – Peer Support Services

12/22/20  2/5/21  Behavioral Health Services - Section 2.3 – Outpatient Services – Peer Support Services
2020-Behavioral Health-9

Behavioral Health Services - Appendix D - Approved Curriculum/Equivalency

12/22/20  2/5/21  Behavioral Health Services - Appendix D - Approved Curriculum/Equivalency
2020-Behavioral Health-8

Behavioral Health Services - Appendix E-4 – Evidenced Based Practices – (EBPs) Policy –  Multi-Systemic Therapy (MST)

 12/21/20 2/4/21  Behavioral Health Services - Appendix E-4 – Evidenced Based Practices – (EBPs) Policy –  Multi-Systemic Therapy (MST)
2020-Independent Labs-1

Independent Laboratories - Section 27.0 - Overview

12/9/20  1/23/21  Independent Laboratories - Section 27.0 - Overview
2020-Independent Labs-2

Independent Laboratories - Section 27.1 – Covered Services

12/9/20  1/23/21  Independent Laboratories - Section 27.1 – Covered Services
2020-Independent Labs-3

Independent Laboratories - Section 27.2 – Provider Requirements

12/9/20  1/23/21  Independent Laboratories - Section 27.2 – Provider Requirements
2020-Independent Labs-4

Independent Laboratories - Section 27.3 - Reimbursement

12/9/20  1/23/21  Independent Laboratories - Section 27.3 - Reimbursement
2020-Independent Labs-5

Independent Laboratories - Appendix A – Fee Schedule

12/9/20  1/23/21  Independent Laboratories - Appendix A – Fee Schedule
2020-ESRD-1

End Stage Renal Disease – Covered Services Section 17.1

12/8/20  1/22/21  End Stage Renal Disease – Covered Services Section 17.1
2020-Professional Services-10

Professional Services - 5.1 – Covered Services – Laboratory and Radiology

12/8/20  1/22/21  Professional Services - 5.1 – Covered Services – Laboratory and Radiology
2020-Hospital-1

Hospital - 25.2 – Inpatient Services

 11/18/20  1/2/21 Hospital - 25.2 - Inpatient Services 
2020-Behavioral Health Services-7

Behavioral Health - Appendix F – Covered Services – CSoC Wraparound Model 

 11/18/20 1/2/21 Behavioral Health - Appendix F – Covered Services - CSoC Wraparound Model 
2020-Behavioral Health Services–6 

Behavioral Health Services - 2.4 – OTP – Addiction  

 11/18/20  1/2/21 Behavioral Health Services - 2.4 – OTP - Addiction   
2020 Behavioral Health Services–5 

Behavioral Health Services - 2.3 – Outpatient Therapy by Licensed Practitioners 

11/18/20   1/2/21 Behavioral Health Services - 2.3 - Outpatient Therapy by Licensed Practitioners 
2020-Behavioral Health Services-4 

Behavioral Health - 2.2 – Bed Based Services (TGH) 

 11/18/20 1/2/21 Behavioral Health - 2.2 – Bed Based Services (TGH) 
2020-Behavioral Health Services–3

Behavioral Health Services - 2.2 – Bed Based Services (PRTF) 

 11/18/20 1/2/21  Behavioral Health Services - 2.2 - Bed Based Services (PRTF) 
2020-Behavioral Health Services-2

Behavioral Health Services - 2.0 – Overview

11/18/20  1/2/21 Behavioral Health Services - 2.0 - Overview
2020-Pharmacy-2

Pharmacy - 37.1– Covered Services

11/18/20 1/2/21 Pharmacy - 37.1– Covered Services
2020-Professional Services-7 Professional Services -5.1 – Covered Services – Obstetrics 11/17/20 1/1/21 Professional Services -5.1 – Covered Services – Obstetrics
2020-Professional Services-8 Professional Services -5.1 – Covered Services – Breast Surgery 11/17/20 1/1/21 Professional Services -5.1 – Covered Services – Breast Surgery
2020-Professional Services-9 Professional Services -5.1 – Covered Services – Bariatric Surgery 11/17/20 1/1/21 Professional Services -5.1 Covered Services Bariatric Surgery
2020-Professional Services-6

Professional Services -5.1 – Covered Services – Concurrent Care

11/13/20 12/28/20 Professional Services -5.1 - Professional Services -Covered Services – Concurrent Care
2020-TRANS-1

Transportation -10.0 – Overview

10/29/20 12/13/20 Transportation -10.0 – Overview
2020-TRANS-2

Transportation -10.1 – Covered Services

10/29/20 12/13/20 Transportation -10.1 – Covered Services
2020-TRANS-3

Transportation -10.2 – Scheduling and Authorization

10/29/20 12/13/20 Transportation -10.2 – Scheduling and Authorization
2020-TRANS-4

Transportation -10.3 – Provider Requirements

10/29/20 12/13/20 Transportation -10.3 – Provider Requirements
2020-TRANS-5

Transportation -10. 4 – Provider Responsibilities

10/29/20 12/13/20 Transportation -10. 4 – Provider Responsibilities
2020-TRANS-6

Transportation -10.5 – Record Keeping

10/29/20 12/13/20 Transportation -10.5 – Record Keeping
2020-TRANS-7

Transportation -10.6 – Ambulance Overview

10/29/20 12/13/20 Transportation -10.6 – Ambulance Overview
2020-TRANS-8

Transportation -10.7 – Emergency Ambulance

10/29/20 12/13/20 Transportation -10.7 – Emergency Ambulance
2020-TRANS-9

Transportation -10.8 – Non Emergency Ambulance

10/29/20 12/13/20 Transportation -10.8 – Non Emergency Ambulance
2020-TRANS-10

Transportation -10.9 – Air Ambulance

10/29/20 12/13/20 Transportation -10.9 – Air Ambulance
2020-TRANS-11

Transportation -10.10 – Ambulance Memberships

10/29/20 12/13/20 Transportation -10.10 – Ambulance Memberships
2020-TRANS-12

Transportation -10.11 – Return Trips and Transfers

10/29/20 12/13/20 Transportation -10.11 – Return Trips and Transfers
2020-TRANS-13

Transportation -10.12 – Claims and Encounters

10/29/20 12/13/20 Transportation -10.12 – Claims and Encounters
2020-TRANS-14

Transportation -10.13 – Record Retention

10/29/20 12/13/20 Transportation -10.13 – Record Retention
2020-TRANS-15 Certification of Ambulance Transportation 10/29/20 12/13/20 Certification of Ambulance Transportation
2020-EarlySteps-1 Overview 10/8/20 11/22/20 Overview
2020-EarlySteps-2 Covered Services 10/8/20 11/22/20 Covered Services
2020-EarlySteps-3 Eligibility Criteria 10/8/20 11/22/20 Eligiblity Criteria
2020-EarlySteps-4 Provider Requirements 10/8/20 11/22/20 Provider Requirements
2020-EarlySteps-5 Program Requirements 10/8/20 11/22/20 Program Requirements
2020-EarlySteps-6 Procedure Codes 10/8/20 11/22/20 Procedure Codes
2020-EarlySteps-7 Definitions/Acronyms 10/8/20 11/22/20 Definitions/Acronyms
2020-Professional Services-1 Professional Services - 5.1 – Diabetes Education 9/21/20 11/5/20 Professional Services - 5.1 – Diabetes Education
2020-Professional Services-2 Professional Services - 5.1 – Newborn Care and Discharge 9/21/20 11/5/20 Professional Services - 5.1 – Newborn Care and Discharge
2020-Professional Services-3 Professional Services - 5.1 – Oral and Maxillofacial Surgery 9/21/20 11/5/20 Professional Services - 5.1 – Oral and Maxillofacial Surgery
2020-Professional Services-4 Professional Services - 5.1 – Outpatient Chemotherapy 9/21/20 11/5/20 Professional Services - 5.1 – Outpatient Chemotherapy
2020-Professional Services-5

Professional Services - 5.1 – Psychiatric Services

9/21/20 11/5/20 Professional Services - 5.1 – Psychiatric Services
2020-Pharmacy-1

Pharmacy - 31.1 - Covered Services

9/21/20 11/5/20 Pharmacy - 31.1 - Covered Services
2020-Behavioral Health Services-1

Behavioral Health Services - 2.4 – Addiction Services

8/21/20  10/5/20  Behavioral Health Services - 2.4 – Addiction Services
2020-Professional Services-1

Professional Services -

5.1 – Covered Services – Routine Care Provided to Beneficiaries Enrolled in Clinical Trials

8/7/20  9/21/20 Section 5.1- Covered Services-Routine Care Provided- Clinical Trials
2020-BH-2

Behavioral Health Services - Appendix E-1 – Evidence Based Practices (EBPs)

7/29/20 9/12/20 Appendix E-1 – Evidence Based Practices (EBP)
2020-Professional Services-4 Professional Services - Section 5.1 – Covered Services - Advance Practice Registered Nurses 7/21/20 9/4/20 Section 5.1 - Covered Services - Advance Practice Registered Nurses
2020-Professional Services-5 Professional Services - Section 5.1 – Covered Services - Chiropractic 7/21/20 9/4/20 Section 5.1 – Covered Services - Chiropractic
2020-Professional Services-6 Professional Services - Section 5.1 – Covered Services - Consultations 7/21/20 9/4/20 Section 5.1 – Covered Services - Consultations
2020-Professional Services-7 Professional Services - Section 5.1 – Covered Services - Hyperbaric Oxygen Therapy 7/21/20 9/4/20 Section 5.1 – Covered Services - Hyperbaric Oxygen Therapy
2020-Professional Services-8

Professional Services - Section 5.1 – Covered Services - "Incident To" Services

7/21/20 9/4/20 Section 5.1 – Covered Services - "Incident To" Services
2020-Professional Services-9

Professional Services - Section 5.1 – Covered Services - Podiatry

7/21/20 9/4/20 Section 5.1 – Covered Services - Podiatry
2020-BH-1

Behavioral Health - Section 2.3 – Outpatient Services - OLP

6/15/20  7/30/20  Section 2.3 – Outpatient Services - OLP
2020-Professional Services-1

Professional Services - Section 5.1 – Covered Services - Genetic Testing

 6/12/20 7/27/20  Section 5.1 – Covered Services - Genetic Testing
2020-FQHC-1

FQHC - Section 22.0 – Overview

5/29/20 7/13/20 22.0 Overview
2020-FQHC-2

FQHC - Section 22.1 – Covered Services

5/29/20  7/13/20  22.1 Covered Services
2020-FQHC-3

FQHC - Section 22.2 – Provider Requirements

5/29/20 7/13/20  22.2 Provider Requirements
2020-FQHC-4 FQHC - Section 22.4 – Reimbursement 5/29/20  7/13/20  22.4 Reimbursement
2020-FQHC-5 FQHC - Appendix F – Behavioral Health Services Examples 5/29/20  7/13/20  Appendix F Behavioral Health Services
2020-Professional Services-1

Professional Services - Section 5.1 – Modifiers

5/19/20  7/3/20  Section 5.1 – Modifiers
2020-Professional Services-2

Professional Services - Section 5.1 – Telemedicine

5/19/20  7/3/20  Section 5.1 – Telemedicine
2020-BH Services-1

Behavioral Health Services - Appendix E-10 – EBP Policy – EMDR Therapy

 5/15/20  6/29/20 Appendix E-10 – EBP Policy – EMDR Therapy
2020-Dental Service-1

Dental Services -16.5 - EPSDT Covered Services

5/15/20 6/29/20  16.5 - EPSDT Covered Services
2020-Dental Services-2 Dental Services – Appendix B – Adult Denture Fee Schedule 5/15/20 6/29/20 Appendix B – Adult Denture Fee Schedule
2020-Dental Service-3 Dental Services – Appendix C – Dental Claim Form Instructions 5/15/20 6/29/20 Appendix C – Dental Claim Form Instructions
2020-Dental Services-4 Dental Services – Appendix F – Claim Denial Simplification 5/15/20 6/29/20 Appendix F – Claim Denial Simplification
2020-ROW-1

Residential Options Waiver - Appendix E -  Billing Codes

3/25/20  5/9/20  Residential Options Waiver - Appendix E -  Billing Codes
2020-PHARM-1

Pharmacy - 37.1 -  Covered Services

 3/19/20  5/3/20 Pharmacy - 37.1 -  Covered Services
2020-BH-3

Behavioral Health Services - 2.6 -  Record Keeping

3/19/20 5/3/20 Behavioral Health Services - 2.6 -  Record Keeping
2020-RHC-1 Rural Health Clinics - Appendix E 3/4/20 4/18/20 Rural Health Clinics - Appendix E
2020-RHC-2 Rural Health Clinics - Appendix F 3/4/20 4/18/20 Rural Health Clinics - Appendix F
2020-BH-1 Behavioral Health Services - Section 2.0 - Overview 2/13/20 3/29/20 Behavioral Health Services - Section 2.0 - Overview
2020-BH-2

Behavioral Health Services - Section 2.3 - Outpatient Services - Rehabilitation Services for Children, Adolescents and Adults

2/13/20 3/29/20 Behavioral Health Services - Section 2.3 - Outpatient Services - Rehabilitation Services for Children, Adolescents and Adults
2020-Supports Waiver-6

Supports Waiver - 43.5 – Program Monitoring

2/10/20 3/26/20 Supports Waiver - 43.5 – Program Monitoring
2020-Supports Waiver-1

Supports Waiver - 43.0 – Overview

2/6/20  3/22/20  Supports Waiver - 43.0 – Overview
2020-Supports Waiver-2

Supports Waiver - 43.1 – Beneficiary Requirements

2/6/20  3/22/20  Supports Waiver - 43.1 – Beneficiary Requirements
2020-Supports Waiver-3

Supports Waiver - 43.2 –  Rights and Responsibilities

2/6/20  3/22/20  Supports Waiver - 43.2 –  Rights and Responsibilities
2020-Supports Waiver-4 Supports Waiver - 43.3 – Service Access Authorization 2/6/20  3/22/20  Supports Waiver - 43.3 – Service Access Authorization
2020-Supports Waiver-5

Supports Waiver – 43.4 – Covered Services

2/6/20  3/22/20  Supports Waiver – 43.4 – Covered Services
2020-DME-1

Durable Medical Equipment - 18.2 – Specific Coverage Criteria

1/28/20  3/13/20  Durable Medical Equipment - 18.2 – Specific Coverage Criteria
2020-DME-2

Durable Medical Equipment - 18.5 – Prior Authorization

1/28/20  3/13/20  Durable Medical Equipment - 18.5 – Prior Authorization
2020-DME-3

Durable Medical Equipment - Appendix E – Contact Referral Information

1/28/20  3/13/20  Durable Medical Equipment - Appendix E – Contact Referral Information
2020-DME-4

Durable Medical Equipment - Appendix I – Breast Pump Form

1/28/20  3/13/20  Durable Medical Equipment - Appendix I – Breast Pump Form
2020-Hospice-1

Hospice – 24.2 – Election of Hospice Care

1/23/20 3/8/20 Hospice – 24.2 – Election of Hospice Care
2020-Hospice-2

Hospice – Appendix C – Hospice Diagnosis Codes

1/23/20 3/8/20 Hospice – Appendix C – Hospice Diagnosis Codes
2019-ABA-1 Section 4.3Service Authorization Process 12/27/19 2/10/20 Section 4.3Service Authorization Process
2019-Pharmacy Benefits Management Services-1 Section 37.0 – Overview 12/12/19 1/26/20 Section 37.0 – Overview
2019-Pharmacy Benefits Management Services-2 Section 37.1 - Covered Services, Limitations, and Exclusions 12/12/19 1/26/20 Section 37.1 - Covered Services, Limitations, and Exclusions
2019-Pharmacy Benefits Management Services-3 Section 37.2 – Provider Requirements and Participation Guidelines 12/12/19 1/26/20 Section 37.2 – Provider Requirements and Participation Guidelines
2019-Pharmacy Benefits Management Services-4 Section 37.3 – Reimbursement for Pharmacy Services 12/12/19 1/26/20 Section 37.3 – Reimbursement for Pharmacy Services
2019-Pharmacy Benefits Management Services-5 Section 37.4 – Managed Care Applicability (NEW) 12/12/19 1/26/20 Section 37.4 – Managed Care Applicability (NEW)
2019-Pharmacy Benefits Management Services-6 Section 37.7 – Reserved 12/12/19 1/26/20 Section 37.7 – Reserved
2019-Pharmacy Benefits Management Services-7 Section 37.8 – Reserved 12/12/19 1/26/20 Section 37.8 – Reserved
2019-Pharmacy Benefits Management Services-8 Section 37.9 – Reserved 12/12/19 1/26/20 Section 37.9 – Reserved
2019-Pharmacy Benefits Management Services-9 Section 37.10 – Reserved 12/12/19 1/26/20 Section 37.10 – Reserved
2019-Pharmacy Benefits Management Services-10 Section 37.11 – Reserved 12/12/19 1/26/20 Section 37.11 – Reserved
2019-Pharmacy Benefits Management Services-11 Section 37.12 – Reserved 12/12/19 1/26/20 Section 37.12 – Reserved
2019-Pharmacy Benefits Management Services-12 Section 37.14 – Reserved 12/12/19 1/26/20 Section 37.14 – Reserved
2019-Pharmacy Benefits Management Services-13 Section 37.16 – Reserved 12/12/19 1/26/20 Section 37.16 – Reserved
2019-Pharmacy Benefits Management Services-14 Section 37.17 – Reserved 12/12/19 1/26/20 Section 37.17 – Reserved
2019-Pharmacy Benefits Management Services-15 Section 37.19 – Reserved 12/12/19 1/26/20 Section 37.19 – Reserved
2019-Pharmacy Benefits Management Services-16 Section 37.20 – Reserved 12/12/19 1/26/20 Section 37.20 – Reserved
2019-Pharmacy Benefits Management Services-17 Section 37.21 – Reserved 12/12/19 1/26/20 Section 37.21 – Reserved
2019-Pharmacy Benefits Management Services-18 Section 37.22 – Reserve 12/12/19 1/26/20 Section 37.22 – Reserved
2019-Pharmacy Benefits Management Services-19 Appendix A – Forms and Links 12/12/19 1/26/20 Appendix A – Forms and Links
2019-Pharmacy Benefits Management Services-20 Appendix B – Claims Related Information 12/12/19 1/26/20 Appendix B – Claims Related Information
2019-Pharmacy Benefits Management Services-21 Appendix C – Glossary 12/12/19 1/26/20 Appendix C – Glossary
2019-Pharmacy Benefits Management Services-22 Appendix D – Contact Information 12/12/19 1/26/20 Appendix D – Contact Information
2019-Pharmacy Benefits Management Services-23 Appendix E – Louisiana Medicaid Single Preferred Drug List (PDL) Fee-for-Service and Managed Care Organizations 12/12/19 1/26/20 Appendix E – Louisiana Medicaid Single Preferred Drug List (PDL) Fee-for-Service and Managed Care Organizations
2019-Pharmacy Benefits Management Services-24 Appendix F – Reserved 12/12/19 1/26/20 Appendix F – Reserved
2019-Pharmacy Benefits Management Services-25 Appendix G – Reserved 12/12/19 1/26/20 Appendix G – Reserved
2019-Pharmacy Benefits Management Services-26 Appendix H – Reserved 12/12/19 1/26/20 Appendix H – Reserved
2019-Pharmacy Benefits Management Services-27 Appendix I – Reserved 12/12/19 1/26/20 Appendix I – Reserved
2019-Pharmacy Benefits Management Services-28 Appendix J – Reserved 12/12/19 1/26/20 Appendix J – Reserved
2019-Pharmacy Benefits Management Services-29 Appendix K – Reserved 12/12/19 1/26/20 Appendix K – Reserved
2019-Pharmacy Benefits Management Services-30 Appendix L – Reserved 12/12/19 1/26/20 Appendix L – Reserved
2019-Pharmacy Benefits Management Services-31 Appendix M – Reserved 12/12/19 1/26/20 Appendix M – Reserved
2019-Pharmacy Benefits Management Services-32 Appendix N – Reserved 12/12/19 1/26/20 Appendix N – Reserved
2019-Professional Services-1 Professional Services – Section 5.1 – Covered Services - Acute Hospital Pre-Certification 12/6/19 1/20/20 Acute Hospital Pre-Certification
2019-Professional Services-2 Professional Services – Section 5.1 – Covered Services - Adjunct Services 12/6/19 1/20/20 Adjunct Services
2019-Professional Services-3 Professional Services – Section 5.1 - Covered Services - Covered Services - Advanced Practice Registered Nurses: Clinical Nurse Specialists, Certified Nurse Practitioners and Nurse Midwives 12/6/19 1/20/20 Advanced Practice Registered Nurses: Clinical Nurse Specialists, Certified Nurse Practitioners and Nurse Midwives
2019-Professional Services-4 Professional Services – Section 5.1 – Covered Services - Allergy Testing 12/6/19 1/20/20 Allergy Testing
2019-Professional Services-5 Professional Services – Section 5.1 – Covered Services - Bariatric Surgery 12/6/19 1/20/20 Bariatric Surgery
2019-Professional Services-6 Professional Services – Section 5.1 – Covered Services - Breast Reconstruction 12/6/19 1/20/20 Breast Reconstruction
2019-Professional Services-7 Professional Services – Section 5.1 – Covered Services - Chiropractic Services 12/6/19 1/20/20 Chiropractic Services
2019-Professional Services-8 Professional Services – Section 5.1 – Covered Services - Cochlear Implants 12/6/19 1/20/20 Cochlear Implants
2019-Professional Services-9 Professional Services – Section 5.1 – Covered Services - Critical Care Services 12/6/19 1/20/20 Critical Care Services
2019-Professional Services-10 Professional Services – Section 5.1 – Covered Services - Diabetes Self-Management Training 12/6/19 1/20/20 Diabetes Self-Management Training
2019-Professional Services-11 Professional Services – Section 5.1 – Covered Services - Early and Periodic Screening, Diagnosis and Treatment (EPSDT) 12/6/19 1/20/20 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) 
2019-Professional Services-12 Professional Services – Section 5.1 – Covered Services - Genetic Testing 12/6/19 1/20/20 Genetic Testing
2019-Professional Services-13 Professional Services – Section 5.1 – Covered Services - Global Surgery Period 12/6/19 1/20/20 Global Surgery Period
2019-Professional Services-14 Professional Services – Section 5.1 – Covered Services - Gynecology 12/6/19 1/20/20 Gynecology
2019-Professional Services-15 Professional Services – Section 5.1 – Covered Services – Hyperbaric Oxygen Therapy 12/6/19 1/20/20 Hyperbaric Oxygen Therapy
2019-Professional Services-16 Professional Services – Section 5.1 – Covered Services - Immunizations 12/6/19 1/20/20 Immunizations
2019-BH-1 Behavioral Health Services - Section 2.4 - Addiction Services 11/7/19 12/22/19 Section 2.4
2019-BH-2 Behavioral Health Services - Section 2.5 - Coordinated System of Care 11/7/19 12/22/19 Section 2.5
2019-RHC-2  Chapter 40 – Rural Health Clinics/40.4 Reimbursement 10/3/19  11/17/19 Section 40.4
2019-RHC-1 Chapter 40 – Rural Health Clinics/40.1 Covered Services 10/3/19 11/17/19 Section 40.1
2019-FQHC-2 Chapter 22 – Federally Qualified Health Centers/22.4 Reimbursement 10/3/19 11/17/19 Section 22.4
2019-FQHC-1 Chapter 22 – Federally Qualified Health Centers/22.1 Covered Services 10/3/19 11/17/19 Section 22.1
2019-ABA-2 Applied Behavior Analysis – Section 4.6 – Coordination of Care 10/1/19 11/15/19 Section 4.6
2019-ABA-1 Applied Behavior Analysis – Section 4.1 – Covered Services 10/1/19 11/15/19 Section 4.1
2019-CCW-1 Community Choices Waiver – Section 7.3 – Recipient Requirements 9/24/19 11/8/19 Section 7.3
2019-ADHC-1 Adult Day Health Care – Section 9.2 – Recipient Requirements  9/24/19  11/8/19 Section 9.2