Clinical Policy Guideline

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Clinical Policy Guideline"

Transcription

1 Policy Title: Ambulance Service Effective Date: 10/25/01 Clinical Policy Guideline Date Reviewed: 01/18/11, 03/19/14, 05/21/14, 07/29/2015 I. DEFINITION Ambulance service means a ground, sea or air vehicle specially designed and equipped to primarily provide transportation for the ill and injured. It provides specialized equipment to treat patients before and during transportation to an appropriate medical facility, and has a crew of at least two persons, in which at least one individual has adequate first aid training for patient care. Emergency is a sudden onset of a medical condition exhibiting itself by acute symptoms of such severity that the absence of immediate medical attention could reasonably be expected to result in any of the following: Placing the patient s health in serious jeopardy; Serious impairment to bodily functions: or Serious dysfunction of any bodily organ or part. Non-emergency refers to all scheduled transportation regardless of origin and destination that does not meet the above criteria for an emergency. Examples of scheduled transportation include, but are not limited to, the following: Hospital discharge trips, Trips to and from end stage renal dialysis (ESRD) facilities for dialysis, To and from other outpatient facilities for chemotherapy or radiation therapy and other diagnostic and therapeutic services. Medical Necessity is established when the patient s clinical condition, at the time the service is provided, is such that the use of any other method of transportation could result in endangering the patient s health, or when another method of transportation is contraindicated, e.g., automobile, taxi, wheelchair van or bus. Coverage is also provided if the patient was bed confined before and after the ambulance trip. Page 1 of 7

2 Bed Confined is defined as the patient s inability to get up from bed without help, and unable to ambulate, and unable to sit in a chair or wheelchair. All three conditions must be met in order to meet the bed confinement definition. II. POLICY/CRITERIA Ambulance service coverage is usually limited to transportation for a covered service from wherever the need may arise to a hospital or skilled nursing facility, or between hospitals or skilled nursing facilities, or from a hospital or a skilled nursing facility to a member s home when it is medically necessary for the member at the time of the service. Documentation supporting medical necessity must be documented, legible and upon request, available for review. A. General requirements for air and ground ambulance are as follows: 1. The vehicle is specially designed and equipped as indicated in the above definition, 2. The vehicle must comply with state or local laws governing the licensing, certification, and equipment requirements of an emergency medical transportation vehicle, 3. The crew (> 2) has specialized training in first aid to provide the necessary medical care services, 4. The trip is medically necessary for the member s condition, and 5. The member satisfies the requirement of bed confined. B. Emergency ground ambulance transport services are covered when the following criteria are met: 1. The member s condition at the time of the ambulance trip satisfies the definition of medical necessity and qualifies as an emergency situation, and 2. The mode of transportation is appropriate to the member s actual medical condition at the time of service, and 3. Subsequent documentation supports the medical necessity, 4. Emergency ground ambulance transport services are covered for local transportation to the closest hospital that can provide medically necessary treatment to the member. C. Emergency Air Ambulance Transportation, (helicopter or fixed wing aircraft) and/or Sea is covered when all of the following criteria are met: 1. When it would take a land ambulance minutes or more to transport an emergency patient, and/or 2. The member s medical condition requires immediate and rapid transport that cannot be provided by either basic or advanced life support land ambulance, and 3. Either the point of pickup is not accessible by land vehicle, or great distances or other obstacles are involved in transporting the member to the nearest appropriate facility, and Page 2 of 7

3 4. The member is being transferred only to the closest acute care hospital that can provide the medically necessary treatment the member requires. D. Non-emergency ambulance transport services must meet the following criteria: 1. Non-emergent transport from inpatient hospital to inpatient hospital for medically necessary care does not require prior authorization. 2. For all other non-emergency ambulance transport services, the following criteria must be met: a) Prior authorization by HealthPlus is required, b) The patient s member s condition met the definition of bed confinement before and after the ambulance trip, and c) The member s condition establishes medical necessity for the ambulance service. F. Exclusions: 1. Non-emergent ambulance transportation (ground, air, and/or sea) of medically stable members for the convenience of the member, member s family, and/or the member s physician is not covered. 2. This exclusion explicitly includes transportation to any medical facility other than the hospital that a HealthPlus Medical Director determines is the most appropriate to provide the medically necessary treatment the member requires. 3. Round trips from a hospital inpatient setting to a medical specialist facility for the convenience of the physician or for the use of medical equipment either available at the institution or that can be transported to the institution. 4. Round trips when a member is taken from a hospital to another facility and returned to the same hospital. As long as the member is an inpatient, all ancillary services are the responsibilities of the hospital. F. Out-of Area and Foreign Ambulance service: 1. Medically appropriate ambulance transportation is a covered benefit regardless of where the service is obtained. 2. Non-emergent interstate air, sea or ground transportation requires a prior authorization by HealthPlus, and is subject to the requirements and exclusions in Section E, above. G. Emergency Health Care Services without Ambulance Transport: In certain circumstances a member may receive health care services from ambulance personnel without subsequent ambulance transportation. Usually, the cost for these services is absorbed by a local governmental agency, since they are considered to offer a community health benefit. However, in rare circumstances members have been billed for these services. When a member has been billed for this Page 3 of 7

4 service, HealthPlus will provide coverage in very limited circumstances, when all the following criteria apply: 1. In the judgment of a prudent observer, an emergency situation did exist when the ambulance services were requested, 2. The ambulance services were not used as a substitute to avoid transportation to, and/or receiving care from, a health care practitioner or facility, 3. Transportation was declined because the precipitating health incident had readily resolved, and did not require further medical intervention or assessment. III. PRIOR AUTHORIZATION REQUIREMENTS Prior authorization by the Medical Director as required in the above criteria. Refer to the Prior Authorization Chart below for Requirements G:\Clinical Policy Committee\BIC R&C FOLDER\Ambulance Service Prior Authorization Requirements.xls IV. CODING/MODIFIERS/LOCATION OF SERVICE Applicable HCPCS Codes: A0225 Ambulance service, neonatal transport, base rate, emergency transport, one way A0420 Ambulance waiting time (ALS or BLS) one-half (1/2 hour) increments. A0425 Ground mileage, per statue mile A0426 Ambulance service, advanced life support, non-emergency, level 1 (ALS 1) A0427 Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 emergency) A0428 Ambulance service, basic life support, non-emergency transport (BLS) A0429 Ambulance service, basic life support, emergency, (BLS emergency) A0430 Ambulance service, conventional air service, transport, and one way (fixed wing) A0431 Ambulance service, conventional air service, transport one way (rotary wing) A0432 Paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third-party payers A0433 Advanced life support, level 2 (ALS 2) A0434 Specialty care transport (SCT) A0435 Fixed wing mileage, per statue mile A0436 Rotary wing air mileage, per statute mile A0998 Ambulance response and treatment, no transport A0999 Unlisted ambulance service Page 4 of 7

5 ***THE ABOVE HCPCS CODES MAY NOT BE COVERED FOR ALL LINES OF BUSINESS*** Modifiers - Must include the appropriate origin and destination modifier on any service line billing for mileage. The first character of the modifier is the origin code and the second character of the modifier is the destination code (e.g. Use modifier RM for a transport from the residence to the emergency room). Origin and Destination Modifiers: D Diagnosis or therapeutic site other than P or H when these are used as origin codes E Residential, domiciliary, custodial facility (nursing home, not skilled nursing facility) G Hospital based dialysis facility (hospital or hospital-related) H Hospital I Site of transfer (e.g., airport or helicopter pad) between types of ambulance J Non-hospital-based dialysis facility N Skilled nursing Facility (SNF) P Physician s office (Includes HMO non-hospital facility, clinic, etc.) R Residence S Scene of accident or acute event X Intermediate stop at a physician s office enroute to the hospital (includes HMO non-hospital facility, clinic, etc.) Destination code only. Modifier X can only be used as a designation code in the second position of a modifier. Used by both ground and air transports: GA The provider or supplier has provided an Advance Beneficiary Notice (ABN) to the patient. GM When more than one patient is transported in an ambulance and document details of the transport. GY Use when billing for a statutorily excluded services. Example patient transport is for noncovered condition that does not meet the definition of any Medicare benefit. The provider is expecting a denial. GZ The provider or supplier expects a medical necessity denial; however, did not provide an Advance Beneficiary Notice (ABN) to the patient. QL Patient pronounced dead after ambulance called QM Ambulance service provided under arrangement by a provider of services QN Ambulance service furnished directly by a provider of services TQ Basic life support transport by a volunteer ambulance provider Location of Service: 41- Ambulance Land 42- Ambulance Air or Water Page 5 of 7

6 V. PRODUCT LINE COVERAGE Please reference contract benefit rider, benefit description, Master Plan Document, Evidence of Coverage (EoC) and Certificate of Coverage (CoC) for applicable limits and copayments, including other exceptions and/or exclusions for specific coverage. If there is a conflict between this medical policy and the individual or group insurance policy document, the terms of the individual or group insurance policy will govern, unless specifically noted. HMO: This policy applies to insured HMO plans; refer to the CoC or benefit rider for exceptions or exclusions. PPO: This policy applies to PPO plans; refer to the CoC for any exceptions or exclusions. SELF-FUNDED OPTIONS: This policy applies to self-funded option plans; refer to the Master Plan Document for any exceptions or exclusions. MEDICARE ADVANTAGE: This policy applies to insured Medicare Advantage plans; refer to the EoC for any exceptions or exclusions. MEDICAID: This policy applies to Medicaid plans; refer to the subscriber contract for exceptions or exclusions. HEALTHY MICHIGAN PLAN: This policy applies to Healthy Michigan Plan; refer to the subscriber contract for any exceptions or exclusions. MICHILD: This policy applies to insured MICHILD plans; refer to the subscriber contract for any exceptions or exclusions. COUNTY HEALTH PLANS: This policy applies to County Health Plans; refer to the benefit description for any exceptions or exclusions. VI. REFERENCES References are available upon request. AMA CPT Copyright Statement: All Current Procedure Terminology (CPT) codes, descriptions, and other data are copyrighted by the American Medical Association. This policy is for informational use only; therefore it is not an authorization of services. HealthPlus of Michigan s clinical policies are developed with the assistance of medical professionals and are based upon a review of published and unpublished information including, but not limited to, current medical literature, guidelines published by public health and health research agencies, and community medical practices in the treatment and diagnosis of disease. Because medical practice, information, and Page 6 of 7

7 technology are constantly changing, HealthPlus of Michigan reserves the right to review and update its clinical policies at its discretion. HealthPlus of Michigan s clinical policies are intended to serve as a resource to the plan; however they are not intended to limit the plan s interpretation of benefit language. HealthPlus of Michigan does not provide health care services and cannot guarantee results or outcomes. Treating providers are solely responsible for rendering medical advice and treatment to members. Page 7 of 7

Medical Coverage Policy Ambulance: Ground Transport

Medical Coverage Policy Ambulance: Ground Transport Medical Coverage Policy Ambulance: Ground Transport Device/Equipment Drug Medical Surgery Test Other Effective Date: 11/29/2001 Policy Last Updated: 6/19/2012 Prospective review is recommended/required.

More information

AMBULANCE SERVICES. Table of Contents

AMBULANCE SERVICES. Table of Contents AMBULANCE SERVICES Protocol: MSC023 Effective Date: 4/1/2015 Table of Contents Page COMMERCIAL COVERAGE RATIONALE... 1 MEDICARE & MEDICAID COVERAGE RATIONALE... 4 DEFINITIONS... 4 APPLICABLE CODES... 5

More information

Medical Coverage Policy Ground Ambulance

Medical Coverage Policy Ground Ambulance Medical Coverage Policy Ground Ambulance Device/Equipment Drug Medical Surgery Test Other Effective Date: 11/29/2004 Policy Last Updated: 12/06/2011 Prospective review is recommended/required. Please check

More information

AMBULANCE SERVICES. Page

AMBULANCE SERVICES. Page AMBULANCE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CS003.C Effective Date: July 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS APPLICABLE CODES... REFERENCES... HISTORY/REVISION

More information

AMBULANCE SERVICES. Page

AMBULANCE SERVICES. Page AMBULANCE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CDG.001.03 Effective Date: June 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE CODES... REFERENCES... HISTORY/REVISION

More information

Clinical Medical Policy Ambulance Transportation. Benefit Coverage

Clinical Medical Policy Ambulance Transportation. Benefit Coverage Benefit Coverage A. Preface Transportation to medical appointments is a benefit for RIte Care, Sub Care, CSN, and RHP members. Members are expected to provide their own transportation to medical appointments;

More information

Medical Policy Original Effective Date: 02-28-2000 Revised Date: 01-27-16 Page 1 of 5. Ambulance Services MPM 1.1 Disclaimer.

Medical Policy Original Effective Date: 02-28-2000 Revised Date: 01-27-16 Page 1 of 5. Ambulance Services MPM 1.1 Disclaimer. Page 1 of 5 Ambulance Services Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all

More information

Clinical Medical Policy Ambulance Transportation

Clinical Medical Policy Ambulance Transportation The intent of this policy is to provide criteria to determine medical necessity for ambulance transportation when authorization is required. for Medicaid Products including: RIte Care, Substitute Care,

More information

Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy

Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy File name: Ambulance and Medical Transport Services (Ground, Air and Water) File code: UM.SPSVC.06 Origination:

More information

Subject: Transportation Services: Ambulance and Non-Emergent Transport

Subject: Transportation Services: Ambulance and Non-Emergent Transport Reimbursement Policy Subject: Transportation Services: Ambulance and Non-Emergent Transport Effective Date: 01/01/15 Committee Approval Obtained: 01/01/15 Section: Transportation ***** The most current

More information

BULLETIN. Medical. Assis. Programs. ssistance. AMBULANCE PROVIDER Policy and Procedure Update ELIMINATION OF LOCAL CODES

BULLETIN. Medical. Assis. Programs. ssistance. AMBULANCE PROVIDER Policy and Procedure Update ELIMINATION OF LOCAL CODES July 2003 Kansas Medical Assis ssistance Programs AMBULANCE PROVIDER Policy and Procedure Update ELIMINATION OF LOCAL CODES BULLETIN Effective with dates of service on and after July 14, 2003, all Ambulance

More information

Subject: Transportation Services: Ambulance and Nonemergent Transport

Subject: Transportation Services: Ambulance and Nonemergent Transport UniCare Health Plan of West Virginia, Inc. Medicaid Managed Care Reimbursement Policy Subject: Transportation Services: Ambulance and Nonemergent Transport Effective Date: 03/01/15 Committee Approval Obtained:

More information

AMBULANCE TRANSPORTATION GROUND

AMBULANCE TRANSPORTATION GROUND AMBULANCE TRANSPORTATION GROUND Policy NHP reimburses licensed ambulance providers for the provision of medically necessary ambulance ground transportation in a medical emergency for NHP members in accordance

More information

Reimbursement Policy. Subject: Transportation Services: Ambulance and Nonemergent Transport. Policy

Reimbursement Policy. Subject: Transportation Services: Ambulance and Nonemergent Transport. Policy Reimbursement Policy Subject: Transportation Services: Ambulance and Nonemergent Transport Effective Date: 12/06/10 Committee Approval Obtained: 08/18/14 Section: Transportation *****The most current version

More information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY Original Issue Date (Created): 7/1/2002 Most Recent Review Date (Revised): 1/27/2015 Effective Date: 6/1/2015 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER

More information

Non-Emergency Non-Ambulance Services - TRANSCITA

Non-Emergency Non-Ambulance Services - TRANSCITA Non-Emergency Non-Ambulance Services - TRANSCITA [Preauthorization Required] Medical Policy: MP-TRANS-01-11 Original Effective Date: March 24, 2011 Reviewed: Revised: This policy applies to products subscribed

More information

TRANSPORTATION SERVICES

TRANSPORTATION SERVICES TRANSPORTATION SERVICES ADMINISTRATIVE POLICY Policy Number: TRANSPORT 002.15 T2 Effective Date: March 1, 2015 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS... COVERAGE RATIONALE...

More information

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Ambulance

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Ambulance KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Ambulance PART II Introduction Section BILLING INSTRUCTIONS Page 7000 Ambulance Billing Instructions............... 7-1 Submission of Claim..................

More information

PA.203.MH Non-Emergent Ambulance Transportation

PA.203.MH Non-Emergent Ambulance Transportation MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.203.MH Non-Emergent Ambulance Transportation This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP MedStar

More information

P o l i c y C h a n g e s

P o l i c y C h a n g e s Wyoming Department Of Health Medicaid EqualityCare Ambulance Services 01-001 Effective January 1, 2001, the 2001 ambulance HCPCS codes went into effect and have been accepted by Wyoming Medicaid since

More information

Ambulance Transportation A Partnership

Ambulance Transportation A Partnership Ambulance Transportation A Partnership DUH and JAS Duke University it Hospital uses Johnston Ambulance Service for a variety of patient transports. Wheelchair Van Services Basic Life Support Service (BLS)

More information

Chapter 27 Non-Emergency Transportation Services

Chapter 27 Non-Emergency Transportation Services Chapter 27 Non-Emergency Transportation Services Overview This chapter provides information on South Country Health Alliance s (SCHA) coverage for Transportation Services. Definitions Access Transportation

More information

10/9/2015. J6: Illinois State Ambulance Association. Today s Presenter. Disclaimer. J6 Provider Outreach and Education Consultant

10/9/2015. J6: Illinois State Ambulance Association. Today s Presenter. Disclaimer. J6 Provider Outreach and Education Consultant J6: Illinois State Ambulance Association October 2015 Add doc ctrl no. Today s Presenter J6 Provider Outreach and Education Consultant Carolyn S Henson CPC,CAC,CACO,CPC-I AAPC I-10 Instructor 2 Disclaimer

More information

(d) Ambulance services means advanced life support services or basic life support services.

(d) Ambulance services means advanced life support services or basic life support services. Initial Proposal DRAFT 6/21/12 1 Readopt with amendment He-W 572, effective 5/30/06 (Document #8638), as amended effective 7/1/12 (Document #10139), to read as follows:] PART He-W 572 AMBULANCE SERVICES

More information

Local Coverage Determination (LCD): Transportation Services: Ambulance (L34302)

Local Coverage Determination (LCD): Transportation Services: Ambulance (L34302) Local Coverage Determination (LCD): Transportation Services: Ambulance (L34302) Contractor Information Contractor Name Cahaba Government Benefit Administrators, LLC LCD Information Document Information

More information

Intermediaries/Carriers

Intermediaries/Carriers Department of Health and Program Memorandum Human Services (DHHS) Intermediaries/Carriers CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) Transmittal AB-01-165 Date: NOVEMBER 14, 2001 CHANGE REQUEST 1555

More information

Chapter 27 Non-Emergency Medical Transportation Services

Chapter 27 Non-Emergency Medical Transportation Services Chapter 27 Non-Emergency Medical Transportation Services Overview This chapter provides information on South Country Health Alliance s (SCHA) coverage for Transportation Services. Definitions Access Transportation

More information

Medicare Ambulance Services

Medicare Ambulance Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Official CMS Information for Medicare Fee-For-Service Providers Medicare Ambulance Services ICN 903194 May 2011 This publication

More information

PROTOCOLS FOR NON-EMERGENCY MEDICAL TRANSPORTATION PROVIDERS

PROTOCOLS FOR NON-EMERGENCY MEDICAL TRANSPORTATION PROVIDERS PROTOCOLS FOR NON-EMERGENCY MEDICAL TRANSPORTATION PROVIDERS CenCal Health members may access Non-Emergency Medical Transportation services when the member does not require emergency services or equipment

More information

Local Coverage Determination (LCD): Ambulance Services (L34549)

Local Coverage Determination (LCD): Ambulance Services (L34549) Local Coverage Determination (LCD): Ambulance Services (L34549) Contractor Name Palmetto GBA Document Information LCD ID L34549 LCD Title Ambulance Services Original Effective Date For services performed

More information

Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383)

Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383) Local Coverage Determination (LCD): Non- Emergency Ground Ambulance Services (L33383) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID

More information

Ambulance Services. Medicaid and Other Medical Assistance Programs

Ambulance Services. Medicaid and Other Medical Assistance Programs Ambulance Services Medicaid and Other Medical Assistance Programs March 2015 This publication supersedes all previous Ambulance Services manuals. Published by the Department of Health and Human Services,

More information

Copyright 2009, National Academy of Ambulance Coding Unauthorized copying/distribution is strictly prohibited

Copyright 2009, National Academy of Ambulance Coding Unauthorized copying/distribution is strictly prohibited Your instructor Levels of Service National Academy of Ambulance Coding Steve Wirth Founding Partner, Page, Wolfberg & Wirth LLC Over 30 years experience as an EMT, Paramedic, Flight Medic, EMS Instructor,

More information

Strategies for Each Payer Type. Medicare: Part 1. Medicare Coverage. Medicare. Medicare Requirements. Reimbursable Events

Strategies for Each Payer Type. Medicare: Part 1. Medicare Coverage. Medicare. Medicare Requirements. Reimbursable Events Strategies for Each Payer Type Medicare: Part 1 Medicare Medicaid Commercial Insurance Auto Insurance Private Pay Contracts Medicare Largest Payer for Ambulance Services Coverage Rules Fee Schedule Medicare

More information

Chapter 1 Section 14

Chapter 1 Section 14 General Chapter 1 Section 14 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(d)(3)(v), 32 CFR 199.14(j)(1)(i)(A), and 10 USC 1079(h)(1) 1.0 APPLICABILITY This policy is mandatory for reimbursement

More information

Ambulance Services. Provider Manual

Ambulance Services. Provider Manual Provider Manual Provider 1 April 1, 2014 TABLE OF CONTENTS Chapter I. General Program Policies Chapter II. Member Eligibility Chapter IV. Billing Iowa Medicaid Appendix III. Provider-Specific Policies

More information

At Elite Ambulance, we are always here to serve you.

At Elite Ambulance, we are always here to serve you. FAQ Important Disclaimer: The following FAQ section includes information regarding health provider decisions, health and payment matters not financial matters. None of the following questions or answers

More information

Anthem Central Region Clinical Claims Edit

Anthem Central Region Clinical Claims Edit Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Electrocardiogram (ECGs) with Ambulance AL & BLS Services Edit

More information

FEE-FOR-SERVICE PROVIDER MANUAL CHAPTER 14 TRANSPORTATION

FEE-FOR-SERVICE PROVIDER MANUAL CHAPTER 14 TRANSPORTATION REVISION DATES: 01/28/2015 clarification 14-10, 14-11, 08/28/2014, 04/17/2014, 03/18/2014, 12/11/2013 Emergency Transportation Services AHCCCS covers emergency ground and air ambulance transportation services,

More information

Chapter. CPT only copyright 2015 American Medical Association. All rights reserved. 9 Ambulance

Chapter. CPT only copyright 2015 American Medical Association. All rights reserved. 9 Ambulance 9 Ambulance Chapter 9 9.1 Enrollment........................................................................ 9-2 9.2 General Information............................................................... 9-2

More information

Local Coverage Determination (LCD) for Transportation Services: Ambulance (L30022)

Local Coverage Determination (LCD) for Transportation Services: Ambulance (L30022) Local Coverage Determination (LCD) for Transportation Services: Ambulance (L30022) Contractor Information Contractor Name Cahaba Government Benefit Administrators, LLC Back to Top LCD Information Document

More information

Provider Handbooks. Ambulance Services Handbook

Provider Handbooks. Ambulance Services Handbook Volume 2 Provider Handbooks Ambulance Services Handbook This manual is available for download at www.tmhp.com, and is also available on CD. There are many benefits to using the electronic manual, including

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Medicare Ambulance Transports

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Medicare Ambulance Transports DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Ambulance Transports ICN 903194 June 2014 This booklet was current at the time it was published or uploaded onto

More information

Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports

Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Quick Reference Information: Coverage and Billing Requirements for Medicare Ambulance Transports ICN 909008 August 2014

More information

Origin Destination Medicare Covers. Home Nursing Home or Hospital Yes. Hospital Home or Nursing Home Yes

Origin Destination Medicare Covers. Home Nursing Home or Hospital Yes. Hospital Home or Nursing Home Yes Billing Requirements For All Transports Definitions: A. Medically Necessary This means that the service given is in the best interest of the patient s health. For ambulance transports, this means that

More information

Final Adoption 6/26/08 114.3 CMR 27.00: AMBULANCE SERVICES. Section

Final Adoption 6/26/08 114.3 CMR 27.00: AMBULANCE SERVICES. Section 114.3 CMR 27.00: AMBULANCE SERVICES Section 27.01: General Provisions 27.02: General Definitions 27.03: General Rate Provisions and Maximum Fees 27.04: Filing and Reporting Requirements 27.05: Severability

More information

Provider Handbooks. Ambulance Services Handbook

Provider Handbooks. Ambulance Services Handbook Provider Handbooks October 2015 Ambulance Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human

More information

Issued and entered This 21 st day of April 2008 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND

Issued and entered This 21 st day of April 2008 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND In the matter of STATE OF MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE REGULATION Before the Commissioner of Financial and Insurance REgulation XXXXX Petitioner File

More information

Ambulance Policy. November 2007! No. 2007-75. Clarification of Wisconsin Medicaid Policy. Documentation Requirements

Ambulance Policy. November 2007! No. 2007-75. Clarification of Wisconsin Medicaid Policy. Documentation Requirements November 2007! No. 2007-75 To: Ambulance Providers HMOs and Other Managed Care Programs Ambulance Policy This Wisconsin Medicaid and BadgerCare Update clarifies existing policies and announces new Wisconsin

More information

Medicare Coverage of Ambulance Services

Medicare Coverage of Ambulance Services CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare Coverage of Ambulance Services This official government booklet explains the following: When Medicare helps cover ambulance services What Medicare pays

More information

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT

MEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:

More information

Transportation Services

Transportation Services INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Transportation Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 5 0 P U B L I S H E D : F E B R U A R Y 2 5, 2 0 1 6

More information

Clinical Policy Guideline

Clinical Policy Guideline Clinical Policy Guideline Policy Title: Bone Density Testing Policy No: B0215A.00 Effective Date: 01/01/15 Date Reviewed: 03/25/15 I. DEFINITION/BACKGROUND Bone density testing is used to estimate the

More information

Ch. 1245 AMBULANCE TRANSPORTATION 55 CHAPTER 1245. AMBULANCE TRANSPORTATION GENERAL PROVISIONS COVERED AND NONCOVERED SERVICES SCOPE OF BENEFITS

Ch. 1245 AMBULANCE TRANSPORTATION 55 CHAPTER 1245. AMBULANCE TRANSPORTATION GENERAL PROVISIONS COVERED AND NONCOVERED SERVICES SCOPE OF BENEFITS Ch. 1245 AMBULANCE TRANSPORTATION 55 CHAPTER 1245. AMBULANCE TRANSPORTATION Sec. 1245.1. Policy. 1245.2. Definitions. GENERAL PROVISIONS COVERED AND NONCOVERED SERVICES 1245.11. Types of services covered.

More information

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014 Medicare 101: Basics of Modifier Billing Part B Provider Outreach and Education February 26, 2014 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345

More information

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT

MEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated

More information

Medical Review of Ambulance Services. Provider Outreach & Education and Medical Review October 2014

Medical Review of Ambulance Services. Provider Outreach & Education and Medical Review October 2014 Medical Review of Ambulance Services Provider Outreach & Education and Medical Review October 2014 Before We Start Help Us Help You! CHAT Area Enter name, facility name and state do not enter in Q&A section

More information

Medicare Benefit Policy Manual Chapter 10 - Ambulance Services

Medicare Benefit Policy Manual Chapter 10 - Ambulance Services Medicare Benefit Policy Manual Chapter 10 - Ambulance Services Transmittals for Chapter 10 10 - Ambulance Service Table of Contents (Rev. 187, 05-01-14) (Rev. 190, 07-11-14) 10.1 - Vehicle and Crew Requirement

More information

P R O V I D E R B U L L E T I N B T 2 0 0 5 0 5 M A R C H 8, 2 0 0 5

P R O V I D E R B U L L E T I N B T 2 0 0 5 0 5 M A R C H 8, 2 0 0 5 P R O V I D E R B U L L E T I N B T 2 0 0 5 0 5 M A R C H 8, 2 0 0 5 To: All Transportation Providers Subject: Transportation Billing Guide Table of Contents Table of Contents... 1 Types of Transportation

More information

Clinical Policy Guideline

Clinical Policy Guideline Policy Title: External Insulin Infusion Pump Effective Date: 11/29/2001 Clinical Policy Guideline Date Reviewed: 07/22/10, 12/13/10, 02/18/11, 09/11, 01/23/13, 06/18/14, 07/29/15 I. DEFINITION An external

More information

Eligibility Molina Dual Options MyCare Ohio Medicare-Medicaid Plan Central West Central Southwest Southwest: West Central: Central:

Eligibility Molina Dual Options MyCare Ohio Medicare-Medicaid Plan Central West Central Southwest Southwest: West Central: Central: Molina Dual Options MyCare Ohio Transportation Benefit Provider Services Molina Healthcare June 2015 Eligibility Molina Dual Options MyCare Ohio Medicare-Medicaid Plan is a health plan that contracts with

More information

Section. CPT only copyright 2007 American Medical Association. All rights reserved. 8Ambulance

Section. CPT only copyright 2007 American Medical Association. All rights reserved. 8Ambulance Section 8Ambulance 8 8.1 Enrollment........................................................ 8-2 8.1.1 Medicaid Managed Care Enrollment................................. 8-2 8.2 Reimbursement....................................................

More information

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING

EXTENDED HOURS HOME CARE SKILLED (PRIVATE DUTY) NURSING Status Active Medical and Behavioral Health Policy Section: Skilled Services Policy Number: IX-01 Effective Date: 04/23/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

206 Capitol Street -3 rd Flr Charleston, WV 25301 P. 304-544-9733 chris@wvemscoalition.com

206 Capitol Street -3 rd Flr Charleston, WV 25301 P. 304-544-9733 chris@wvemscoalition.com July 24, 2015 WV Bureau for Medical Services Transportation 350 Capitol Street, Room 251 Charleston, WV 25301 BMS.comments@wv.gov RE: Transportation, Chapter 524, and appendix To Whom It May Concern: The

More information

Florida Medicaid AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS HANDBOOK

Florida Medicaid AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS HANDBOOK Florida Medicaid AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration August 2013 UPDATE LOG AMBULANCE TRANSPORTATION SERVICES COVERAGE AND LIMITATIONS

More information

Tennessee Ambulance Services Association Conference

Tennessee Ambulance Services Association Conference Tennessee Ambulance Services Association Conference Nashville, TN October 7, 2014 Clinical Education Presented by Julia McKinley, RN, MAED Provider Outreach and Education Disclaimers This resource is not

More information

Intermediaries/Carriers

Intermediaries/Carriers Department of Health and Program Memorandum Human Services (DHHS) Intermediaries/Carriers HEALTH CARE FINANCING ADMINISTRATION (HCFA) Transmittal AB-00-88 Date: SEPTEMBER 18, 2000 CHANGE REQUEST 1281 THE

More information

Chapter. CPT only copyright 2008 American Medical Association. All rights reserved. 9Ambulance

Chapter. CPT only copyright 2008 American Medical Association. All rights reserved. 9Ambulance Chapter 9Ambulance 9 9.1 Enrollment........................................................ 9-2 9.2 Emergency Ground Ambulance Transportation.............................. 9-2 9.2.1 Benefits, Limitations,

More information

MODIFIERS. Original Effective Date: July 7, 2009 Revision Date: February 1 st, 2014

MODIFIERS. Original Effective Date: July 7, 2009 Revision Date: February 1 st, 2014 Original Effective Date: July 7, 2009 Revision Date: February 1 st, 2014 MODIFIERS Policy s are used to increase accuracy in recording patient encounters and compensation. A modifier provides the means

More information

Effective Ambulance Service Auditing: A Suggested Approach

Effective Ambulance Service Auditing: A Suggested Approach Feature Effective Ambulance Service Auditing: A Suggested Approach By R. Michael Scarano, Jr. Executive Summary Because the Medicare rules governing ambulance services are complex and unique, providers

More information

Division of Medicaid and Health Financing Updated July 2013 SECTION 2 MEDICAL TRANSPORTATION. Table of Contents

Division of Medicaid and Health Financing Updated July 2013 SECTION 2 MEDICAL TRANSPORTATION. Table of Contents SECTION 2 MEDICAL TRANSPORTATION Table of Contents 1 MEDICAL TRANSPORTATION SERVICES (Updated 7/1/13)... 3 1-1 Credentials for Transportation Providers... 3 1-2 Verifying Medicaid Eligibility... 4 1-3

More information

Provider Handbooks. Ambulance Services Handbook

Provider Handbooks. Ambulance Services Handbook Provider Handbooks November 2015 Ambulance Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human

More information

Fraud and Abuse Emergency Medical Services and Ambulance Services

Fraud and Abuse Emergency Medical Services and Ambulance Services Fraud and Abuse Emergency Medical Services and Ambulance Services William C. Krasner JD,MBA,RN,EMT,CHC What I Will Share Overview of Emergency Medical Services The Problem OIG Compliance Guide Coverage

More information

Chapter. CPT only copyright 2009 American Medical Association. All rights reserved. 9Ambulance

Chapter. CPT only copyright 2009 American Medical Association. All rights reserved. 9Ambulance Chapter 9Ambulance 9 9.1 Enrollment........................................................ 9-2 9.2 Emergency Ground Ambulance Transportation.............................. 9-2 9.2.1 Benefits, Limitations,

More information

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE 11:3-29.1 Purpose and scope (a) This subchapter implements the provisions

More information

8.324.7.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.324.7.1 NMAC - Rp, 8.324.7.1 NMAC, 1-1-14]

8.324.7.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.324.7.1 NMAC - Rp, 8.324.7.1 NMAC, 1-1-14] TITLE 8 SOCIAL SERVICES CHAPTER 324 ADJUNCT SERVICES PART 7 TRANSPORTATION SERVICES AND LODGING 8.324.7.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.324.7.1 NMAC - Rp, 8.324.7.1 NMAC,

More information

Inpatient or Outpatient Only: Why Observation Has Lost Its Status

Inpatient or Outpatient Only: Why Observation Has Lost Its Status Inpatient or Outpatient Only: Why Observation Has Lost Its Status W h i t e p a p e r Proper patient status classification affects the clinical and financial success of hospitals. Unfortunately, assigning

More information

Chapter 16. Medicaid Provider Manual

Chapter 16. Medicaid Provider Manual Chapter 16 Medicaid Provider Manual CHAPTER 16 Date Revised: TABLE OF CONTENTS 16.1 Emergency/Ambulance Services... 1 16.2 Non-Emergency Ground Transportation... 2 16.2.1 Taxi Services... 2 16.2.2 Curb-to-Curb

More information

When you document an incident, you are writing for several different audiences. There s the legal audience the number of records requests we receive

When you document an incident, you are writing for several different audiences. There s the legal audience the number of records requests we receive 1 When you document an incident, you are writing for several different audiences. There s the legal audience the number of records requests we receive from attorneys continues to grow. There s the patient

More information

FEE SCHEDULE NEW YORK STATE MEDICAID TRANSPORTATION

FEE SCHEDULE NEW YORK STATE MEDICAID TRANSPORTATION FEE SCHEDULE NEW YORK STATE MEDICAID TRANSPORTATION NYS Medicaid Transportation Schedule Ambulance A0422 A0420 A0424 A0425 A0426 A0427 A0428 A0429 A0430 A0431 A0432 A0433 A0434 A0435 A0436 A0999 Advanced

More information

EDMONDS FIRE DEPARTMENT. Emergency Medical Services Transport User Fees. Frequently Asked Questions

EDMONDS FIRE DEPARTMENT. Emergency Medical Services Transport User Fees. Frequently Asked Questions EDMONDS FIRE DEPARTMENT Emergency Medical Services Transport User Fees Frequently Asked Questions Have a Question About a Medical Transport Bill? Call a Customer Service Rep At Systems Design Northwest

More information

Chapter 4 Health Care Management Unit 1: Care Management

Chapter 4 Health Care Management Unit 1: Care Management Chapter 4 Health Care Unit 1: Care In This Unit Topic See Page Unit 1: Care Care 2 6 Emergency 7 4.1 Care Healthcare Healthcare (HMS), Highmark Blue Shield s medical management division, is responsible

More information

SUBSCRIPTION TERMS AND CONDITIONS

SUBSCRIPTION TERMS AND CONDITIONS SUBSCRIPTION TERMS AND CONDITIONS Subscribers of Jefferson Hills Area Ambulance Association hereinafter referred to as JHAAA, receive the benefit of unlimited access to basic and advanced life support

More information

1. Transportation Services

1. Transportation Services Table of Contents 1.... 1 1.1. Introduction... 1 1.1.1. Non-Emergency Record Keeping Requirements... 1 1.2. Ambulance... 1 1.3. Non-Emergent Transportation (NET)... 1 1.3.1. Freedom of Choice... 1 1.3.2.

More information

Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes

Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes SECTION 19 - S 19.1 PRIOR CONTENTS NO LONGER APPLICABLE... 2 19.2 S... 2 19.2.A BASIC LIFE SUPPORT (BLS) BASE RATE... 2 19.2.B ADVANCED LIFE SUPPORT (ALS) BASE RATE... 3 19.2.C SPECIALIZED TESTING AND

More information

Medicare Coverage of Ambulance Services. CENTERS for MEDICARE & MEDICAID SERVICES

Medicare Coverage of Ambulance Services. CENTERS for MEDICARE & MEDICAID SERVICES CENTERS for MEDICARE & MEDICAID SERVICES Medicare Coverage of Ambulance Services This official government booklet explains: When Medicare helps cover ambulance services What you pay What Medicare pays

More information

WYOMING MEDICAID RULES CHAPTER 15 AMBULANCE SERVICES

WYOMING MEDICAID RULES CHAPTER 15 AMBULANCE SERVICES WYOMING MEDICAID RULES CHAPTER 15 AMBULANCE SERVICES Section 1. Authority These rules are promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W.S. 42-4-101 et

More information

Fidelis Care NY State of Health: The Official Health Plan Marketplace Standard Products

Fidelis Care NY State of Health: The Official Health Plan Marketplace Standard Products PRODUCT INFORMATION Fidelis Care NY State of Health: The Official Health Plan Marketplace Standard Products NY State of Health: The Official Health Plan Marketplace (the Marketplace) is an online insurance

More information

NON-EMERGENCY MEDICAL TRANSPORTATION

NON-EMERGENCY MEDICAL TRANSPORTATION NON-EMERGENCY MEDICAL TRANSPORTATION Brief Coverage Statement Non-Emergency Medical Transportation (NEMT) is provided as an administrative service for Colorado Medical Assistance Program (Colorado Medicaid)

More information

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Observation Care Services Description:

More information

Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes

Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes SECTION 19 - S 19.1 PRIOR CONTENTS NO LONGER APPLICABLE...2 19.2 S...2 19.2.A BASIC LIFE SUPPORT (BLS) BASE RATE...2 19.2.B ADVANCED LIFE SUPPORT (ALS) BASE RATE...3 19.2.C SPECIALIZED TESTING AND TREATMENT...3

More information

Division of Medicaid and Health Financing SECTION 2 MEDICAL TRANSPORTATION. Table of Contents

Division of Medicaid and Health Financing SECTION 2 MEDICAL TRANSPORTATION. Table of Contents Division of Medicaid and Health Financing Updated July 2015 SECTION 2 MEDICAL TRANSPORTATION Table of Contents 1 MEDICAL TRANSPORTATION SERVICES... 3 1-1 Credentials for Transportation Providers... 3 1-2

More information

Clinical Policy Guideline

Clinical Policy Guideline Clinical Policy Guideline Policy Title: Obesity Medical/Surgical Management Effective Date: 07/13/2004 Date Reviewed: 06/18/2011, 12/15/2011, 02/22/2012, 06/26/2012, 07/16/2012, 01/23/2013, 11/26/2014,

More information

Frequently Asked Questions from Medical Practitioners

Frequently Asked Questions from Medical Practitioners Frequently Asked Questions from Medical Practitioners How can the Facility Department help? LogistiCare maintains a Facility Services Department dedicated to handling the non-emergency medical transportation

More information

AIR AMBULANCE SERVICES

AIR AMBULANCE SERVICES Protocol: OTH019 Effective Date: April 11, 2012 AIR AMBULANCE SERVICES Table of Contents Page COMMERCIAL, MEDICARE & MEDICAID COVERAGE RATIONALE... 1 BACKGROUND... 7 APPLICABLE CODES... 7 REFERENCES...

More information

MEDICAL POLICY No. 91332-R3 NON-ACUTE INPATIENT SERVICES

MEDICAL POLICY No. 91332-R3 NON-ACUTE INPATIENT SERVICES NON-ACUTE INPATIENT SERVICES Effective Date: November 16, 2007 Review Dates: 1/93, 12/99, 12/01, 12/02, 11/03, 11/04, 10/05, 10/06, 10/07, 10/08, 10/09, 10/10, 10/11, 10/12, 10/13, 11/14 Date of Origin:

More information

Division of Medical Services

Division of Medical Services Division of Medical Services Program Planning & Development P.O. Box 1437, Slot S-295 Little Rock, AR 72203-1437 501-682-8368 Fax: 501-682-2480 TO: Arkansas Medicaid Health Care Providers Transportation

More information

January March 31, 2015 Ambulance Fee Schedule Public Use Files

January March 31, 2015 Ambulance Fee Schedule Public Use Files Background January March 31, 2015 Ambulance Fee Schedule Public Use Files The Ambulance Fee Schedule was implemented on April 1, 2002. The accompanying public use files reflect updates effective for ambulance

More information