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2012 Texas Medicaid Provider Procedures Manual

Ambulance Services Handbook : 2. Ambulance Services : 2.2 Services/Benefits, Limitations, and Prior Authorization : 2.2.5 Types of Transport

Multiple Client Transports
Multiple client transports occur when more than one client with Medicaid coverage is transported simultaneously in the same vehicle. A claim for each client must be completed and must reference multiple transfers with the names and Medicaid numbers of other clients sharing the transfer in Block 19 of the CMS-1500 paper claim form. Providers must enter charges on a separate claim for each client. TMHP adjusts the payment to 80 percent of the allowable base rate for each claim and divides mileage equally among the clients who share the ambulance.
Refer to:
Subsection 6.4, “Claims Filing Instructions” in Section 6, “Claims Filing” (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
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