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8.3 Benefits and Limitations
The Texas Medicaid Program reimburses for nonemergency and emergency transports.
For ground transportation, providers must bill procedure codes 9-A0428 and 9-A0425, for nonemergency transports or 9-A0429 and 9-A0425 with modifier ET for emergency transport. Providers must bill the appropriate mileage with the appropriate base rate procedure code.
For air transportation, providers must bill either with procedure codes 9-A0430 and 9-A0435, or 9-A0431 and 9-A0436. Providers must bill the appropriate mileage with the appropriate base rate procedure code.
When submitting a claim for water transport services, providers are to use procedure code 9-A0999. The claim suspends for manual review and pricing.
Cardiopulmonary resuscitation (CPR) billed as an ambulance service by an ambulance provider will be denied.
The payment rates represent a global payment. It is inappropriate to bill for any supplies or other services related to the transport, unless otherwise specified in this section.
The accuracy of the information about a client's condition which requires the transport and the medical necessity of the transport are the responsibility of the ambulance provider. The ambulance provider may be sanctioned, including exclusion from the Medicaid Title XIX programs, for completing or signing a claim form that includes false or misleading representations of the client's condition or the medical necessity of the transport.
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