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December 2016 Texas Medicaid Provider Procedures Manual

Ambulance ServicesHandbook : 2 Ambulance Services : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.5 Types of Transport

2.2.5
2.2.5.1
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 billed with the transport procedure code and the mileage procedure code with the GM modifier that indicates multiple client transport. Claims must include the names and Medicaid numbers of other Texas Medicaid clients who shared the transfer, or indicate “Not a Medicaid client” in Block 19 of the CMS 1500 paper 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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