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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 : Air or Specialized Vehicle Transports
Air ambulance transport services, by means of either fixed or rotary wing aircraft, and other specialized emergency medical services vehicles may be covered only if one of the following conditions exists:
Claims for air ambulance transports procedure codes A0430 and A0431 must be submitted with the corresponding air mileage procedure code A0435 or A0436.

Texas Medicaid & Healthcare Partnership
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