TMPPM 2008 > Texas Medicaid Services > Ambulance > Ambulance Procedure Codes

    
 

8.8 Ambulance Procedure Codes

Use the following procedure codes when billing for ambulance services provided to Medicaid-eligible clients:

Emergency Code
Limitations
Maximum Fee

9-A0382

Maximum allowable fee of $20.30 is per transport, not to exceed $40.60 round trip.

$20.30

9-A0420

 
*

9-A0422

 
*

9-A0424

 
*

9-A0425

with modifier ET

Use modifier ET to denote emergency services. A0425-ET is denied if it is billed without A0429.

$4.50

9-A0429

 
$250.00

9-A0430

 
$2,250.00

9-A0431

 
$3,000.00

9-A0435

 
$16.24

9-A0436

 
$16.24

9-A0999

Use for water ambulance services.

Manually Priced
*Reimbursed at reasonable charge, which is the lesser of the provider's customary profile, the prevailing profile, or the provider's actual charge in accordance with 1 TAC §355.8600.

Nonemergency Code
Limitations
Maximum Fee

9-A0382

Maximum allowable fee of $20.30 is per transport, not to exceed $40.60 round trip.

$20.30

9-A0420

 
*

9-A0422

 
*

9-A0424

 
*

9-A0425

A0425 is denied if it is billed without A0428

$4.50

9-A0428

 
$200.00

9-A0430

 
$2,250.00

9-A0431

 
$3,000.00

9-A0435

 
$16.24

9-A0436

 
$16.24
*Reimbursed at reasonable charge, which is the lesser of the provider's customary profile, the prevailing profile, or the provider's actual charge in accordance with 1 TAC §355.8600.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
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