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1 Wyoming Department Of Health Medicaid EqualityCare Ambulance Services Effective January 1, 2001, the 2001 ambulance HCPCS codes went into effect and have been accepted by Wyoming Medicaid since that time. Medicaid has also continued to accept claims using the previous codes from the HCFA 1500 policy manual. However, as of September 1, 2001, the "old" codes will no longer be accepted, with the exception of HCPCS codes A0382, A0398, A0422, A0380 and A0390, which will remain active. In addition, code A0425 will no longer be allowed after September 1, See page 5 of this bulletin for the crosswalk of new and old codes. Ambulance services should be reported using both new and old HCPCS codes which reflect the different categories. As in the past, an ambulance trip report must be attached to all claims. The new policy, using Medicare Policy as a guideline, has five categories of ground ambulance services and two categories of air ambulance services. The categories are: a. Basic Life Support (BLS); b. Basic Life Support Emergency; c. Advanced Life Support, Level 1 (ALS1); d. Advanced Level 1 Emergency; e. Advanced Life Support, Level 2 (ALS2); f. Fixed Wing Air Service; and g. Rotary Wing Air Service. The category definitions are in alliance with the National EMS Education and Practice Blueprint from EMT. Inside this Bulletin: P o l i c y C h a n g e s Policy Changes 1 National EMS Definitions 2-3 Limitations 4 Coding Crosswalk 5

2 Page 2 NATIONAL EMS DEFINITIONS: Basic Life Support (BLS) is treatment rendered by personnel certified at the Basic Emergency Care Technician (BEC) or basic Emergency Medical Technician (EMT) level, including procedures such as bandaging, splinting, basic first aid, and performing CPR. Basic Emergency Care Technician (BEC) is an individual who has completed an approved training program in basic emergency care sponsored by the Division, Department of Health, Office of Emergency Medical Services (OEMS), or has Division-approved equivalency training. A Basic Emergency Care Technician shall not practice alone as an ambulance attendant in Wyoming. Emergency Medical Technician (EMT) is an individual who has completed an approved training program that adheres to the National Emergency Medical Services Educational and Practical Blueprint or a Division-sponsored or Division-approved training program for EMT's and who continues to meet all the applicable continuing medical education recertification requirements. A m b u l a n c e S e r v i c e s Ambulance Services: Independent Ambulance or Hospital Based Ambulance services are reimbursed if they meet Medicaid coverage guidelines and when the appropriate services are rendered for the beneficiary's condition. Categories of Service 1) Ground Service: Basic Life Support (BLS) - When medically necessary, the provision of BLS services as defined in the National EMS Education and Practice Blueprint for the EMT-Basic. A) Basic Life Support (BLS) - Emergency - The provision of BLS services as described above in an emergency situation. An emergency response is one that is provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in: 1. Placing the beneficiary's health in serious jeopardy; 2. Impairment to bodily functions; or 3. Serious dysfunction to any bodily organ or part.

3 Page 3 B) Advanced Life Support, Level 1 (ALS1) - The Advanced Life Support, Level 1 category is the provision of an assessment by an advanced life support (ALS) provider or supplier or the provision of one or more ALS interventions. An ALS provider/ supplier is defined as a provider trained to the level of the EMT- Intermediate or Paramedic as defined in the National EMS Education and Practice Blueprint. An ALS intervention is defined as any procedure beyond the scope of an EMT-Basic as defined in the National EMS Education and Practice Blueprint. ALS Assessment is an assessment performed by an ALS crew that results in the determination that the patient's condition requires an ALS level of care, even if no other ALS intervention is performed. In the above situation, the EMT-Intermediate or Paramedic must actually ride on the BLS transport for the BLS ambulance provider to bill an ALS service. C) Advanced Life Support, Level 1 - (ALS1) Emergency - The provision of ALS1 services, as specified above, in the context of an emergency response. An emergency response is one that is provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in: An ambulance trip report must be attached to all claims. 1. Placing the beneficiary's health in serious jeopardy; 2. Impairment to bodily functions; or 3. Serious dysfunction to any bodily organ or part. D) Advanced Life Support, Level 2 - (ALS2) - The Advanced Life Support, Level 2 category is: 1. The administration of three or more different medications, and 2. The provision of at least one of the following ALS procedures:! Manual defibrillation/cardioversion! Endotracheal intubation! Central venous line! Cardiac pacing! Chest decompression! Surgical airway! Intraosseous line

4 Page 4 2) A i r S e r v i c e s E & F) Fixed Wing and Rotary Wing - These air ambulance services are reimbursable when transport meets Medicaid coverage requirements, and the beneficiary's medical condition is such that transport by ground ambulance, in whole or part, is not appropriate. Transport by fixed wing or rotary wing air ambulance may be necessary because the beneficiary's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, i.e., heavy traffic, preclude such rapid delivery to the nearest appropriate facility. Transport by fixed wing or rotary wing air ambulance may also be necessary because the beneficiary is inaccessible by a land or water ambulance vehicle. Wyoming Medicaid does not reimburse for the following ambulance services: Notable changes include: 1. Transportation to receive services which are not covered by Wyoming Medicaid 2. Transportation which does not involve transporting a recipient (i.e., noload trips) 3. Transportation of family members to visit a recipient or to consult with their physician 4. Transportation to pick up drugs at a pharmacy 5. Return transportation to a recipient's home or nursing home if ambulance transportation is not medically necessary 6. Transportation of a nursing home resident to a physician's office or outpatient hospital department if the care can be furnished in the recipient's care facility 7. Transportation to a hospital or other health service facility for the purpose of detention ordered by a court or law enforcement agency 8. Stand-by time 9. Special attendants 10. Unloaded mileage 11. Services based on standing orders 12. Specialty Care Transport (SCT) 13. Paramedic Intercept (PI)! The limitation "transportation of a recipient pronounced dead before medical transportation is called", has been deleted.! Return transportation to a recipient's home or nursing home, if ambulance transportation is not medically necessary, has been added.

5 Wyoming Medicaid/ Equality Care Ambulance Coding Crosswalk Page 5 Previous Code (2000) Description Current Code (as of 9/1/01) Fee ($) GROUND BLS A0382 BLS, routine disposable supplies A A0422 Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation A A0380 BLS ground Mileage (per mile) A A0320 Ambulance Service, BLS, non-emergency transport, mileage and disposable supplies billed separately A A0322 Ambulance Service, BLS, emergency transport, mileage and disposable supplies billed separately A GROUND ALS A0398 ALS, routine disposable supplies A A0422 Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation A A0390 ALS ground mileage (per mile) A A0326 A0330 Ambulance Service, ALS1, non-emergency transport, specialized ALS services rendered, mileage and disposable supplies separately billed Ambulance Service, ALS1, emergency transport, specialized ALS services rendered, mileage and disposable supplies separately billed A A N/A Ambulance Service, ALS2, mileage and disposable supplies billed separately A AIR AMBULANCE A0030 Ambulance Service, conventional air services, transport, one way, fixed wing A A0040 Ambulance Service, conventional air services, transport, one way, rotary wing A A0221 Fixed wing air mileage, per statute mile A A0221 Rotary wing air mileage, per statute mile A **** A0425 BLS & ALS mileage (Active 4/01/01-9/01/01); inactivated because Medicare doesn't cover; previously accepted codes will remain active A0380 & A

6 Wyoming Department Of Health Medicaid EqualityCare ACS/Consultec P.O. Box 667 Cheyenne, WY Phone: or in Cheyenne Fax: I M P O R T A N T C H A N G E S I N S I D E - P L E A S E R E A D

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