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December 2016 Texas Medicaid Provider Procedures Manual

Ambulance ServicesHandbook : 2 Ambulance Services : 2.4 Claims Filing and Reimbursement : 2.4.8 Extra Attendant : 2.4.8.2 Nonemergency Transports

2.4.8.2
Prior authorization is required when an extra attendant is needed for any nonemergency transport. When a client’s condition changes, such as a need for oxygen or an extra attendant for transport, the prior authorization request must be updated.
To receive prior authorization, the requesting provider must prove medical necessity and identify attendant services that could not be provided by the basic crew. The information supporting medical necessity must be kept in the requesting provider’s medical record and is subject to retrospective review.
Texas Medicaid does not reimburse for an extra attendant based only on an ambulance provider’s internal policy.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.