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December 2016 Texas Medicaid Provider Procedures Manual

Ambulance ServicesHandbook

Ambulance Services
Handbook
Table of Contents
1 General Information 4
2 Ambulance Services 4
2.1 Enrollment 4
2.1.1 Subscription Plans 4
2.2 Services, Benefits, Limitations, and Prior Authorization 5
2.2.1 Emergency Ambulance Transport Services 5
2.2.1.1 Prior Authorization for Emergency Out-of-State Transport 6
2.2.2 Nonemergency Ambulance Transport Services 6
2.2.3 Levels of Service 7
2.2.4 Oxygen 7
2.2.5 Types of Transport 7
2.2.5.1 Multiple Client Transports 7
2.2.5.2 Air or Specialized Vehicle Transports 8
2.2.5.3 Specialty Care Transport (SCT) 8
2.2.5.4 Transports for Pregnancies 8
2.2.5.5 * Transports to or from Prescribed Pediatric Extended Care Centers (PPECC) 8
2.2.5.6 Transports to or from State Institutions 8
2.2.5.7 Not Medically Necessary Transports 8
2.2.5.8 Transports for Nursing Facility Residents 9
2.2.5.9 Emergency Transports Involving a Hospital 9
2.2.5.10 No Transport 10
2.3 Documentation Requirements 10
2.3.1 Medicaid Surety Bond Requirements 10
2.4 Claims Filing and Reimbursement 11
2.4.1 Claims Information 11
2.4.2 Reimbursement 11
2.4.2.1 Ambulance Disposable Supplies 11
2.4.2.2 Payment Window Reimbursement Guidelines for Services Preceding an Inpatient Admission 11
2.4.3 Medicare and Medicaid Coverage 12
2.4.3.1 Medicare Services Paid 12
2.4.3.2 Medicare Services Denied 12
2.4.4 Ambulance Claims Coding 12
2.4.4.1 Place of Service Codes 13
2.4.4.2 Origin and Destination Codes 13
2.4.4.3 Transports Billed Without Mileage 14
2.4.5 Air or Specialized Vehicle Transports 14
2.4.6 Emergency Transport Billing 14
2.4.7 Nonemergency Transport Billing 15
2.4.8 Extra Attendant 15
2.4.8.1 Emergency Transports 15
2.4.8.2 Nonemergency Transports 16
2.4.9 Night Call 16
2.4.10 Waiting Time 16
2.4.11 Appeals 16
2.4.12 Relation of Service to Time of Death 17
2.5 Claims Resources 17
2.6 Contact TMHP 17
3 Forms 17
4 Claim Form Examples 17
 
 

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