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Updated Guidelines for Treatment-in-Place Ambulance Services

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after December 1, 2023, the guidelines for treatment-in-place (TIP) ambulance services will be updated for Texas Medicaid as follows:

  • TIP services provided to a client must be performed under the supervision of a physician, such as the medical director of the ambulance company, or under the supervision of a health care professional, such as a physician assistant or advanced nurse practitioner, who is contracted by the ambulance company.
  • Ambulance staff must provide TIP in accordance with their emergency transport service’s medical direction and established protocols.

The medical services provided under the supervision of a physician or health care professional must be billed separately by the physician or health care professional who provides supervision of care on the scene using the appropriate codes.

Ambulance providers may only bill for initiating or facilitating TIP using the corresponding emergency ground transport procedure code (A0427 or A0429).

Additional Updates to the Ambulance Services Handbook

In addition to the TIP information noted above, the following information will be added to the Texas Medicaid Provider Procedures Manual, Ambulance Services Handbook on December 1, 2023:

  • Documentation requirements for physical restraints: type of restraint, time frame for use of the restraint, and the client’s condition
  • Modifier ET requirement for emergency triage, treat, and transport (ET3) services; procedure codes submitted without modifier ET are subject to prior authorization requirements

For more information, call the TMHP Contact Center at 800-925-9126.