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4.3.2.6 Emergency Care
If an emergency medical condition occurs, the limited restriction does not apply. The term emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain), such that the absence of immediate medical attention could reasonably be expected to result in:
• Placing the patient's health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.
•Serious impairment to bodily functions.
•Serious dysfunction of any bodily organ or part.
Important: A provider who sends in an appeal because a claim was denied with 00066 must include the performing provider identifier, not just a name or group provider identifier. Appeals without a performing provider identifier are denied. The license number of the designated provider must be entered in Block 83 on the UB-04 CMS-1450 or in the appropriate electronic field for nonemergency inpatient and outpatient claims to be considered for reimbursement.
Note: Only when the designated provider or designated provider representative has given permission for the client to receive nonemergency inpatient and/or outpatient services, including those provided in an emergency room, can the facility use the designated provider's license number for billing.
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