Other place of service not identified above. Hospitalization Dates Related to Current Service. A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to tribal members admitted as inpatients or outpatients. A taxicab service means passenger transportation by a common carrier on a call-and-demand basis in a taxicab, with the first passenger therein having exclusive use of the taxicab unless such passenger agrees to multiple loading. Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. Ride-sharing companies are not enrolled providers and the Department is unable to pay for or reimburse for use of these services. Basic Life Support (BLS) A0429 A0425 A0424 Ambulance service, BLS, emergency transport (BLS emergency); Ground mileage, per statute mile; Extra ambulance attendant, ALS or BLS (requires medical review). Enter the date of service using two digits for the month, two digits for the date and two digits for the year. There is no limit to the number of daily trips a client can receive from one or multiple providers, but those trips must meet all NEMT regulatory and policy requirements. HCPCS Level II codes are updated by CMS. These cookies will be stored in your browser only with your consent. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. 722. A facility whose primary purpose is education. Enter code R68.89 for all claims. Heres how you know. Ambulance and Other Transport Services and Supplies, Ambulance service, outside state per mile, transport (Medicaid only), Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest, Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest, Non-emergency transportation and bus, intra or inter state carrier, Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems, Non-emergency transportation: wheel-chair van, Non-emergency transportation and air travel (private or commercial) intra or inter state, Non-emergency transportation: per mile - case worker or social worker, Transportation ancillary: parking fees, tolls, other, Copyright 2023. Specialty: Transportation Broker - Non-Emergency Medical Specialty Code: 326 This is for NEMT providers, that are providing services within the State-contracted brokers service area: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer, and Weld Counties. Health First Colorado uses the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedural Coding System (HCPCS). The following paper form reference table shows required, optional, and conditional fields and detailed field completion instructions for the EPSDT claim form. Nonmedical transportation (NMT) is transportation by private or public vehicle for people who do not have another way to get to their appointment. This cookie is set by GDPR Cookie Consent plugin. Ambulance Rides CPT Codes. Submitted information appears on the Remittance Advice (RA). Use CMS place of service codes. Revised: October 20, 2021. Transportation after discharge from a hospital, Failure of a NEMT provider to pick up a member from an appointment within one hour of the scheduled pick up time. A mobility/ambulatory vehicle is a passenger-carrying vehicle for hire, including those designed, constructed, modified or equipped to meet the needs of passengers with medical, physical or mobility impairments and, when medically necessary, their certified escorts. The codes are used for submitting claims for services provided to Health First Colorado members and represent services that may be provided by enrolled, certified Health First Colorado providers. Complete if the member is covered by a commercial health care insurance policy. Enter the HCPCS procedure code that specifically describes the service for which payment is requested. Moreover, coding and billing are strictly based on this recorded documentation, so the documentation must be complete and accurate. Is there another Health Benefit Plan? Comprehensive Inpatient Rehabilitation Facility. The Rate & Fee Schedule is updated annually around July 1 with the new rates implemented by the legislature for the new State Fiscal Year. Medical CPT codes are critical to streamlining reporting and increasing accuracy and efficiency, as well as for administrative purposes such as claims processing and developing guidelines for medical care review. The member has a behavioral or medical condition which may cause the member to be a threat to self or others if only one escort is provided, or. w+dis[2rXsQi Comprehensive Outpatient Rehabilitation Facility. an NEMT provider. Share sensitive information only on official, secure websites. If in the nine-county broker service area, contact the State-Designated Entity in the area to determine the need for providers, and the policies and procedures in that area. Healthcare providers should record correct clinical documentation during the case for reimbursement. A diagnosis is required on all claims. Insured's or Authorized Person's Signature, 14. NEMT is a Profitable Business To sum it up, non-emergency medical transportation income varies between about $30,000 and $56,000 a year for each vehicle on the road. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. CPT code A0427: A0427 is a valid 2022 HCPCS code for Ambulance service, advanced life support, emergency transport, level 1 (Als1 - emergency), sometimes known as "Als1-emergency" for short. 4. b: False. 2023 HCPCS A-Codes - Transportation Services Including Ambulance, Medical & Surgical Supplies HCPCS Transportation Services Including Ambulance, Medical & Surgical Supplies HCPCS Sections A Codes Transportation Services Including Ambulance, Medical & Surgical Supplies B Codes Enteral and Parenteral Therapy C Codes (Description change effective January 1, 2016). But an emergency medical technician (EMT) may be the primary provider on prehospital ambulance transport. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Example: 010116 for January 1, 2016. Enter the number of units provided for each procedure code. ( Ambulance Transportation Response to Call A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. If transportation is provided to the member in response to a 9-1-1 call, and the service meets the requirements of EMT, the service may be billed as EMT services. A provider cannot bill NMT services through their NEMT Provider ID. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 28 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Mobility/ambulatory vehicle providers must have, and maintain one of the following PUC licenses, or be determined exempt by PUC statutes: Providers must provide services in compliance with PUC licensure and state and federal laws. Carriage Paid To (CPT) is an international commercial term (Incoterm) denoting that the seller incurs the risks and costs associated with delivering goods to a carrier to an agreed-upon. CPT code A0428: Ambulance service, basic life support, and non-emergency transportation are all available in this code mentioned above. The HCPCS codes range Transportation Services T2001-T2007 is a standardized code set necessary for Medicare and other health insurance providers to provide healthcare claims. Meals and lodging are limited to one unit per day each, per member or escort. endobj Generally, hospitalists directly interact with ambulance transport teams who have picked patients up from their homes or other nonmedical settings and brought them to the hospital. NEMT must be used to access the closest qualified Health First Colorado provider willing and able to treat the member. or means youve safely connected to the .gov website. An escort may accompany a member when: NEMT may cover the cost of transporting a second escort with written certification for medical necessity from the member's medical provider, if: Minors who are at least thirteen (13) years old, but younger than eighteen (18) years old, may travel alone with a written release from their parent or guardian, as long as an adult is present to receive the minor at the destination and at the return location. A wheelchair van is a vehicle for hire that has been specifically designed, constructed, modified, or equipped to accommodate the needs of wheelchair users. Medical Transportation Fee-for-Service Demand Response Transportation Services Providers (including Transportation Network Companies) Reimbursement Information for Procedure Code T2003 Last updated on 7/20/2021 Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. %PDF-1.7 Refer to the Enter an "N" or leave blank for NO in the bottom, unshaded area of the field to indicate the service was non-emergent medical transportation. A mobility vehicle may submit claims using wheelchair van procedure codes only when the member is a wheelchair user and the vehicle has been modified with appropriate wheelchair equipment. 'B' Codes. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Drive cautiously at safe speeds, observing traffic laws, Encourage the utilization of the Department of Transportation National Highway Traffic Safety Administration Emergency Vehicle Operating Course (EVOC), and National Standard Curriculum, Billing service for a group practice with your current software, Billing Service for Medicaid and Medicare, Possible appeals to maximize your revenue. The diagnosis must be referenced to each detail line by placing a "1" in the diagnosis indicator field. NEMT is available to all beneficiaries when their medical and physical condition does not allow them to travel by bus, passenger car, taxicab, or another form of public or private transportation. Meals and lodging for members are available for: Meals and lodging may be covered for the escort when a member is a child or an at-risk adult who requires the escort's continued stay. Clarified interfacility transfers, 9-1-1 response calls, and unit limits for ancillary services. Fields 24A through 24J apply to each billed line. Codes and Rates Ground medical transportation services are reimbursed as listed below. When billing for one member taking multiple trips in the same day with the same rendering provider, modifier 76 must be used. If these requirements are not met, the mobility/ambulatory vehicle may not bill using wheelchair van codes. Enter N or leave blank to indicate the service was non-emergency medical transportation. Transportation for Health First Colorado members to and from a medical provider is a benefit when the medical service provided is a benefit of the Health First Colorado and the provider is enrolled with Health First Colorado to deliver the service. Emergency Medical Services (EMS) Subscription Programs are regulated by the DSHS-EMS Compliance Group. These cookies ensure basic functionalities and security features of the website, anonymously. Services must be prescribed by a health care provider. The Department has established a State Designated Entity (SDE) responsible for administering NEMT in nine Colorado counties: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer, and Weld. In the shaded portion of the field, enter the NPI or Provider ID of the Health First Colorado provider who actually performed or rendered the billed service. Non-emergent medical transportation (NEMT) is transportation to and from medically necessary services covered by Health First Colorado (Colorado's Medicaid program) for members who have no other means of transportation, including free transportation. Train transport is a Health First Colorado service when the member's medical professional indicates that the member requires train transportation in order to be transported safely and they are unable to use less costly modes of NEMT services. Service (procedure) code: Reflects the NEMT transport service provided or reimbursed as indicated in the following tables. lock Procedure Code. Great distances or other obstacles prohibit transporting the member by land to the nearest appropriate facility and the member's condition requires immediate attention. Do not use commas when reporting dollar amounts. Example: A123456. Non-emergent air ambulance benefits are provided when: Non-emergent air ambulance service is a Health First Colorado service when the member's medical professional indicates, in writing, that the member requires air ambulance in order to be transported safely and they are unable to use less costly modes of NEMT services. Contact our Account Receivables Specialist today! In-state treatment when travel cannot be completed in one calendar day. Non-emergency medical transportation (NEMT) is an important benefit for people who need assistance getting to and from medical appointments. However, you may visit "Cookie Settings" to provide a controlled consent. Lodging providers are not required to obtain PUC or ambulance licensure but must enroll as a Health First Colorado NEMT provider in order to submit claims for services. This online MHCP Provider Manual is your primary information source for MHCP coverage policies, rates and billing procedures and is updated on an ongoing basis. The SDE is responsible for ensuring documentation from the member's medical professional indicates, in writing, the member is unable to use less costly modes of NEMT services (e.g., mileage reimbursement, bus tickets). A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. 7 What are the CPT codes for ambulance transportation? Place an "X" in the box marked as Medicaid. Wheelchair Van N'JTHU5aQv2G^x&3jV+];fc23c--Va>C$Nn@D.@k7[:UzrW;5BRS3;nhq8]h{dl[cKA#tzb;P&/7Z%h^h~,/]^={5T ) 11. The selection of codes is based on the patients condition at the time of transport as well as services rendered. Enter the total amount paid by Medicare or any other commercial health insurance that has made payment on the billed services. Shipping and handling shall be billed using the Workers Compensation unique procedure and modifier code: 99070 SH. In this case, the taxi company agrees to the Health First Colorado reimbursement for mobility /ambulatory vehicles. End-Stage Renal Disease Treatment Facility. website belongs to an official government organization in the United States. The following services are not Health First Colorado NEMT benefits: Title 42 CFR, 431.53 requires states to: Please visit the Electronic Code of Federal Regulations website for more information. Commercial Air Services that can be billed HCPCS code Description Fee schedule A0425 Ground mileage, per statute mile Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. Units of Service: Code Description Unit of Service A0130 Non-emergency transportation; wheelchair van 1 base rate A0170 Parking Tolls and Fees 1 unit Added Urgent Transportation. Use the appropriate number of units to identify the actual number of riders. Licensure, or proof of exemption from licensure requirements, must be included in the Health First Colorado NEMT provider application. When applicable, enter the words "TRANSPORT CERT" to certify that you have a transportation certificate or trip sheet on file for this service.