Louisiana Workers’ Comp Fee Schedule: Rates, Deadlines, Disputes

The Louisiana workers’ compensation fee schedule caps what insurers and employers pay for medical care given to injured workers, setting each covered service at the mean of usual and customary charges in the state — or the provider’s actual charge, whichever is lower.¹ The Office of Workers’ Compensation Administration (OWCA) publishes the schedule and can adjust rates annually. It covers hospitals, physicians, physical therapists, chiropractors, pharmacies, dental providers, and rehabilitation services delivered to any worker covered under Chapter 10 of Title 23.²

How the Rates Are Calculated

OWCA collects billing data from Louisiana providers and calculates the average charge for each procedure. That average becomes the maximum reimbursable amount. Services are identified by Current Procedural Terminology (CPT) codes, and each code carries its own rate. When a provider’s actual charge is lower than the scheduled amount, the insurer pays the lower figure.¹

Dental services use a different benchmark. Reimbursement is capped at the 70th percentile of the National Dental Advisory Service Comprehensive Fee Report, adjusted by Louisiana-specific geographic multipliers.² That percentile-based formula tends to run more generous than the mean-based formula used elsewhere.

The same fee schedule applies to in-state and out-of-state treatment. Louisiana permits care from out-of-state providers when comparable care is not reasonably available in-state or can be obtained at comparable cost, and those providers are subject to the same rate caps and utilization review as in-state providers.¹ When the injury and the treatment cross state lines, providers can contact the carrier to confirm which state’s system governs the claim.³

Pharmacy Reimbursement

Prescription drugs follow a separate formula tied to the Average Wholesale Price (AWP) in the most recent monthly update of the Annual Pharmacists’ Reference Red Book:⁴

Brand-name drugs: the lowest of the provider’s usual charge, a contracted rate, or AWP plus 10% plus the state’s Medicaid dispensing fee.
Generic drugs: the lowest of the provider’s usual charge, a contracted rate, or AWP plus 40% plus the Medicaid dispensing fee.
Compounded prescriptions: reimbursed using the generic formula.

The generic markup is larger because generic AWPs start lower; the higher percentage still typically produces a lower total payment than the brand equivalent.

The $750 Pre-Authorization Threshold

A provider can perform up to $750 in non-emergency diagnostic testing or treatment without the insurer’s consent. Beyond that, the provider and insurer must agree on further care, or the insurer can send the request to a utilization review company to assess medical necessity.⁵

Emergency care is exempt. A treating provider who determines that care is immediately necessary does not need pre-authorization regardless of cost.⁶

This is where many claims fail. Providers who cross the $750 line without approval risk nonpayment for the excess. Request authorization early, and document the request.

Medical Necessity and Documentation

Every billed service must be medically necessary. To qualify, care must be clinically appropriate for the work-related injury, consistent with the Louisiana Medical Treatment Schedule, not provided solely for the patient’s convenience, and delivered in the least intensive setting the patient’s condition allows.⁷

Providers should report the most complete diagnosis on the claim form, make sure billed services match that diagnosis, and keep clinical records with the physical findings and history that support both. Services unrelated to the workplace injury are not payable, and screening tests with no connection to the on-the-job condition are excluded.⁷ Medical documentation must also comply with Title 40 of the Louisiana Administrative Code and applicable federal and state privacy and security rules.⁸

Payment Deadlines

The payment clock depends on how the bill arrives. Carriers are required to accept electronic bills, though provider participation in electronic billing is voluntary.⁹

Electronic bills: insurers must pay within 30 days of receiving a complete electronic medical bill.
Paper bills: insurers must pay within 60 days of receiving written notice of the charges.

Both deadlines come from R.S. 23:1201.¹⁰

Penalties for Late Payment

When an insurer misses the 30- or 60-day deadline, the penalty is the greater of 12% of the unpaid medical benefits or $50 per calendar day the bill remains unpaid. The daily portion is capped at $2,000 per claim, and total penalties at a single hearing are capped at $8,000 regardless of how many violations exist. Reasonable attorney fees are assessed on top.¹⁰

The consequences climb when an insurer fails to pay a final, non-appealable judgment. If the award goes unpaid more than 30 days, the insurer owes the greater of 24% of the award or $100 per calendar day, plus attorney fees. The daily portion is capped at $3,000.¹⁰ On a larger claim, the 24% surcharge alone can outweigh the amount originally in dispute.

Disputing a Denial or Modification

When an insurer denies a treatment request or approves it only with changes, Louisiana provides a fast, structured challenge path.

Voluntary Reconsideration

Every denial notice must include a phone number for someone with authority to reverse the decision. If the carrier agrees during this window, which runs up to 10 calendar days, no formal filing is needed.⁶

Medical Director Review

The aggrieved party files Form LWC-WC-1009 with OWCA within 15 calendar days of receiving the denial or modification. A “deemed denial” also starts that clock: if the carrier does not respond within five business days of the authorization request, the silence counts as a denial. The filing must include the 1009 form, a copy of the LWC-WC-1010 showing the communication history with the carrier, and all previously submitted documentation. The OWCA medical director issues a written decision within 30 calendar days.⁶

Judicial Review

Either party can seek judicial review by filing Form LWC-WC-1008 with a workers’ compensation district office within 15 calendar days of the date the medical director’s decision was mailed. The judge sets an expedited hearing 15 to 30 calendar days after receiving the appeal. A party wanting an additional medical opinion for the review must ask for it at or before the pretrial conference; later requests are denied unless the judge finds good cause or that another examination serves the interest of justice. Mediation is not available for these disputes.¹¹

The 15-day filing windows are strict. Missing one forfeits that level of review.

When PPO Discounts Change the Math

The fee schedule is a ceiling, not a floor. If a provider belongs to a preferred provider organization (PPO) network and has contractually agreed to a discount, the insurer can pay the discounted rate rather than the full schedule amount. The Louisiana Supreme Court has upheld this arrangement on the reasoning that the employer is paying what the provider agreed to charge; in the case that reached the court, the provider received 20% less than the schedule rate under a PPO contract, and the reduced payment stood. Providers weighing network participation should measure the referral volume against the discount.

Mileage Reimbursement for Injured Workers

Injured workers who travel for medical care receive mileage reimbursement. Effective January 1, 2026, the Louisiana workers’ compensation rate is $0.725 per mile, set by OWCA — considerably higher than the IRS standard medical mileage rate of $0.205 per mile for 2026. Workers should keep a log of every trip: date, destination, and round-trip distance. Reimbursement claims turn on the records.

1
Louisiana State Legislature. Louisiana Revised Statutes RS 23:1203 – Medical and Surgical Treatment
2
Louisiana State Legislature. Louisiana Revised Statutes RS 23:1034.2 – Reimbursement Schedule
3
Cornell Law School. Louisiana Administrative Code Title 40 I-5151 – Out-of-State On-the-Job Injuries or Work-Related Illness Treated in Louisiana
4
Cornell Law School. Louisiana Administrative Code Title 40 I-2907 – Reimbursement
5
Louisiana State Legislature. Louisiana Revised Statutes RS 23:1142 – Approval of Health Care Providers and Fees
6
Cornell Law School. Louisiana Administrative Code Title 40 I-2715 – Medical Treatment Schedule Authorization and Dispute Resolution
7
Cornell Law School. Louisiana Administrative Code Title 40 I-2717 – Medical Review Guidelines
8
Cornell Law School. Louisiana Administrative Code Title 40 I-315 – Medical Documentation Necessary for Billing Adjudication
9
Cornell Law School. Louisiana Administrative Code Title 40 I-306 – Electronic Medical Billing and Payment Companion Guide
10
Louisiana State Legislature. Louisiana Revised Statutes RS 23:1201 – Time and Place of Payment
11
Justia Law. Louisiana Revised Statutes 23:1317.1 – Additional Medical Opinion Regarding Medical Examinations