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9.2.3 Nonemergency Ground Ambulance Transportation
Nonemergency ambulance transport must be to or from a scheduled medical appointment at the nearest appropriate facility for medically necessary care that is approved by the CSHCN Services Program.
The client's current medical condition requiring the nonemergency ambulance transport must be indicated clearly on the claim. When submitting claims for nonemergency ambulance transport, providers must use HCPCS procedure codes 9-A0425 and 9-A0428.
The ambulance provider is responsible for the integrity of the information about the client's condition necessitating the transport and the medical necessity of the transport. The ambulance provider may be sanctioned, including exclusion from the CSHCN Services Program, for completing or signing a claim form that includes false or misleading representation of the client's condition or of the medical necessity of the transport.
Hospitals are allowed to release a patient's protected health information (PHI) to a transporting emergency medical services provider for treatment, payment and health-care operations.
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