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8.3.1.2 Emergency Transport Billing
When billing emergency transports electronically, a minimum of one diagnosis description or the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code must be entered on the claim form or in the diagnosis code field for electronic billers. A claim that has "see attached" as the only information in the diagnosis block is not processed for payment consideration.
Transports may be appealed as emergency claims only. Emergency transports that are denied cannot be accepted on appeal as nonemergency transports. Emergency transports billed as nonemergency services are denied.
Note: Emergency and nonemergency claims may be billed electronically to the Texas Medicaid Program. For electronic billers, the hospital's provider identifier must be entered in the Facility ID field. Providers should consult their software vendor for the location of this field on the electronic claim form.
All emergency claims submitted on paper are required to have the following documentation:
• Distance of transport traffic patterns.
•Time of transport.
•Acuity of client.
Place of Service Codes
National place of service (POS) codes 41 and 42 are accepted by the Texas Medicaid Program.
Condition Codes
Electronic billers should use as many condition codes as needed to fully describe the client's condition.
The following condition codes are accepted by the Texas Medicaid Program:
Condition code 60 is used to notify TMHP that the client was taken to the nearest facility.
Origin and Destination Codes
All claims submitted on paper or electronically must include the two-digit origin and destination codes. The origin is the first digit, and the destination is the second digit. The following are the origin and destination codes accepted by the Texas Medicaid Program:
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