2018-33: Reminder: Medicaid Outpatient Fee Schedule Quantity Limits Per Day

Date: 07/02/18

As a reminder, the Louisiana Department of Health (LDH) publishes Medicaid Fee-For-Service (FFS) files with procedure codes, modifiers, rates and quantity limits for youth and adults.

With regard to the Outpatient Hospital Services Fee Schedules, Louisiana Healthcare Connections will enforce the quantity limits as outlined in the Louisiana Medicaid Outpatient Fee Schedule.

When the UVS>1 is ‘blank’, there is 1 unit limit per day. Any procedure code filed in excess of the allowed unit per day will be denied as EX35 (Deny: Benefit Maximum Reached).

To avoid denial, providers should submit claims based on the Medicaid fee schedule and follow the instructions in terms of procedure code, modifier, place of service, limitations and any other requirements issued.

The applicable fee schedules are available on the Louisiana Medicaid website, www.LaMedicaid.com.