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Ambulance Transportation Billing Guide Washington Apple Health (Medicaid) Ambulance Transportation Billing Guide January 1, 2021 Disclaimer Every effort has been made to ensure this guide’s accuracy. If an actual or apparent conflict between this document and a Health Care Authority (HCA) rule arises, HCA rules apply. Billing guides are updated on a regular basis. Due to the nature of content change on the internet, we do not fix broken links in past guides. If you find a broken link, please check the most recent version of the guide. If this is the most recent guide, please notify us at [email protected]. About this guide* This publication takes effect January 1, 2021, and supersedes earlier billing guides to this program. HCA is committed to providing equal access to our services. If you need an accommodation or require documents in another format, please call 1-800-562- 3022. People who have hearing or speech disabilities, please call 711 for relay services. Washington Apple Health means the public health insurance programs for eligible Washington residents. Washington Apple Health is the name used in Washington State for Medicaid, the children’s health insurance program (CHIP), and state-only funded health care programs. Washington Apple Health is administered by the Washington State Health Care Authority. Refer also to HCA’s ProviderOne Billing and Resource Guide for valuable information to help you conduct business with HCA. How can I get HCA Apple Health provider documents? To access provider alerts, go to HCA’s provider alerts webpage. To access provider documents, go to HCA’s provider billing guides and fee schedules webpage. Where can I download HCA forms? To download an HCA form, see HCA’s Forms & Publications webpage. Type only the form number into the Search box (Example: 13-835). * This publication is a billing instruction. 2 | AMBULANCE TRANSPORTATION BILLING GUIDE Copyright disclosure Current Procedural Terminology (CPT) copyright 2020 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. What has changed? Subject Change Reason for Change Definitions Added reference Ease of finding definitions in to WAC 182-546- WAC. 0125 for ambulance specific definitions. Correction Updated evaluation and treatment facility definition as certified by Department of Health rather than DSHS Clarification on what constitutes a Added definition voluntary transport; definition was for voluntary missing from the guide behavioral health transport About the program Removed Both services are covered “emergency and nonemergency” from air ambulance bullet Added language Clarification that all ambulance transportation services must be medically necessary 3 | AMBULANCE TRANSPORTATION BILLING GUIDE Subject Change Reason for Change Provider Removed “mental Mental health and substance use responsibilities- health” and disorder falls under behavioral documenting “substance use health services disorder” and billed/provided replaced with “behavioral health” Title of form 42-0003 changed; Updated title of the form includes ITA and ITA form 42-0003 voluntary transportation to Authorization of Secure Ambulance Transportation to/from Behavioral Health Services Clarification on billing voluntary Added language behavioral health transportation for billing for voluntary transports and adding SCI=V on the claim note section Reporting material Added language Ease of finding where to report changes in provider to report changes changes status to provider enrollment and added link to enrollment page Knowing healthcare Removed section Outside of the scope of the resources in service program. Providers are to follow area Department of Health (DOH) guidelines. Coverage – when Added language Clarification that ambulance does HCA not pay “or when medical service transportation to a client’s for ambulance necessity has home may be covered services been established” 4 | AMBULANCE TRANSPORTATION BILLING GUIDE Subject Change Reason for Change Treat but no Removed general Treat but no transport is covered transport service WAC reference in some instances. Referenced calls 182-546 and WACs cover those exceptions. added WAC for treat and refer and noncovered services. Added link to Treat and Refer section of the guide Removed blue Information is clarified in section box about above with WAC references instances of when covered Removed Redundant language transport language under ALS assessment Transfer to an Added language To align with WAC 182-546-0425 equivalent or lower HCA “may” pay level of care with a “signed PCS/NPCS.” Also added language that transfers strictly for convenience are not covered services. See WAC 182-546- 0250 Removed ETR information Removed Nonemergency Transfer Request form Removed blue box indicating PCS is not authorization for transfer down To align with WAC 182-546-1500 services Removed HCA does not pay for air ambulance 5 | AMBULANCE TRANSPORTATION BILLING GUIDE Subject Change Reason for Change Is out-of-state Added blue note To clarify which cities are ambulance box “Transports considered in-state transports as transportation to border cities as listed in WAC 182-501-0175. covered outlined in WAC 182-501-0175 are considered in- state transports” Does HCA pay for Removed Is presumptive language that is ambulance language not needed transportation home regarding medical condition being considered resolved Removed An ETR can be requested language that transportation to a client’s home is not covered Not required for claim submission Removed but documentation must kept language for with ambulance provider claims showing documentation Does HCA pay for Added language Clarification that a dialysis PCS is ambulance “A PCS for good for longer periods that a transportation to a dialysis is good regular PCS kidney dialysis for up to three center months per authorization span.” Does HCA pay for Add language for Clarification nonemergency transportation to ambulance “and from” a transportation to a physician’s office physician’s office Added language Clarification on when PCS is for PCS/NPCS required and needed for renewal. requirements for To align with WAC. medical necessity Removed Applies to all clients “residing in a nursing facility” Removed Outside of scope of program; specialty services specialty services evaluation is language done at the clinical level 6 | AMBULANCE TRANSPORTATION BILLING GUIDE Subject Change Reason for Change Authorization Removed Clarification language “all nonemergency ambulance transportation requires PA”. Added that nonemergency air and nonemergency ground to/from out-of-state facilities require PA When is the Out-of- Removed Unnecessary language State Medical language “not Services request experimental” form, HCA 13-787 Added language and companion “or have prior Clarification of MCO requirements General Information approval from the for Authorization managed care form, HCA 13-835, plan” required? Removed language on No longer valid centers used for out-of-state services When is the Remove the word A court order AND a PCS/NPCS Authorization of “required” can be used in place of form 42- Secure Ambulance 0003 Transportation to/from Behavioral Health Services form, HCA 42-0003 required? Who can sign a Removed Old information PCS/NPCS effective January 1, 2020 7 | AMBULANCE TRANSPORTATION BILLING GUIDE Subject Change Reason for Change Payable Under destination Clarification circumstances for air of acute care ambulance services hospital, added language “for emergency air transport and approved trauma center” Added language “for nonemergency air transports, the client’s destination is an acute care hospital or approved rehabilitation facility” When does HCA pay Removed section HCA does not make supplemental for ambulance payments for trauma cases. transportation of qualified trauma cases Does HCA cover Added note to Clarification: Border cities are not emergency blue box covered for ambulance services transportation “including border under the ITA program provided out-of- cities” state Does HCA authorize Added language Clarification nonemergency air “HCA-contracted ambulance MCO” transportation to out-of-state treatment facilities? 8 | AMBULANCE TRANSPORTATION BILLING GUIDE Table of Contents Resources Available ......................................................................................................................... 14 Definitions ............................................................................................................................................ 15 About the Program .......................................................................................................................... 19 What is the ambulance transportation program? ........................................................ 19 When does HCA pay for ambulance transportation?................................................. 19 What are the guidelines for emergency medical transportation? ....................... 20 What about scheduled or “brokered” (nonemergency) medical transportation? .............................................................................................................................. 20 Client Eligibility .................................................................................................................................
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