Transportation Modifier List Two (2) digit alphabetical originator and destination modifiers are used in conjunction with medical transportation procedure codes for processing purposes. EMTs are typically undergone approximately 40 to 100 hours of medical training in which a small portion may be pediatric. Complete if the member is covered by a commercial health care insurance policy. All other providers - Public Utilities Commission (PUC) or County. Use place of service codes: Each detail line must include a valid NEMT procedure code. 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. An official website of the United States government Service (procedure) code: Reflects the NEMT transport service provided or reimbursed as indicated in the following tables. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. Example: 010116 for January 1, 2016. Non-Emergent Medical Transportation (NEMT) Billing Manual, HCBS Non-Medical Transportation (NMT) Providers, Types of Non-Emergent Medical Transportation, Transportation Third Party Claim - No Mileage Example, the Electronic Code of Federal Regulations website, Volunteer Vehicle Mileage - vehicle provided by volunteer (individual or organization), with no vested interest, Individual Vehicle Mileage - vehicle provided by individual (family member, self, neighbor) with vested interest, Nonemergency transportation: Ambulance service- Basic Life Support (BLS), Nonemergency transportation: Ambulance service- Advanced Life Support (ALS), level 1, Ambulance service- Advanced Life Support (ALS), level 2, Ambulance service, outside state per mile, transport, Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation, Ambulance service, conventional air services, transport, one way (fixed wing), Ambulance service, conventional air services, transport, one way (rotary wing). Be a current Health First Colorado member, receiving Medicaid State Plan / Title XIX coverage on the date of service. Services are billable on professional claims (837P) only. 4. b: False. A0130 is a valid 2023 HCPCS code for Non-emergency transportation: wheelchair van or just " Noner transport wheelch van " for short, used in Ambulance . 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. Services must be prescribed by a health care provider. If transportation is for the purpose of receiving a service that could have been safely and effectively provided in the point of origin then the transport is not covered even if the beneficiary could only have gone by ambulance. A wheelchair van is a vehicle for hire that has been specifically designed, constructed, modified, or equipped to accommodate the needs of wheelchair users. Emergency Medical Services(EMS) is included in Ambulanceand patient transport services while privateambulance services which supply various services such as emergency prehospital care, basic medical support and roadside transport to hospitals for patients experiencing medical emergencies, However, ambulance transportation has certain risk such as high speeds and the use of lights, sirens, which potentially results in ambulance crashes that may injure or cause the death of patients, providers, pedestrians. Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. Each claim must bear the signature of the enrolled provider or the signature of a registered authorized agent. 11. Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. Insured's or Authorized Person's Signature, 14. All NEMT train trips must be prior approved by the Department (See Prior Authorization). The SDE explores and utilizes the least costly, medically-appropriate means of transportation for each member and arranges those transportation services. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Telehealth Provided Other than in Patients Home, Process for Requesting New Codes or Modification of Existing Codes, Place of Service Codes for Professional Claims (PDF), A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization. An EMS provider must have specific approval to operate a subscription program. (Effective January 1, 2003). (This code is available for use immediately with a final effective date of May 1, 2010), A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual. Enter N or leave blank to indicate the service was non-emergency medical transportation. Refer to the 3 What is the CPT code for shipping and handling? This number cannot be assigned to a group or clinic. 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. A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. Diagnosis or Nature of Illness or Injury. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. You can decide how often to receive updates. NEMT can only be used to access approved medical services. Attachment 3.1.-D, Methods of Assuring Transportation covers NEMT and specifies the methods used to ensure transportation for members, as required by 42 CFR, 431.53. We use cookies to ensure that we give you the best experience on our website. Enter the HCPCS procedure code that specifically describes the service for which payment is requested. Transportation Procedure Codes, Modifiers and Payment Rates . Hospitalization Dates Related to Current Service. The Department's NEMT web page is a brief overview of NEMT and includes some resources. 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. If field 11d is marked "YES", enter the policy or group number. Share sensitive information only on official, secure websites. Heres how you know. 3 What is the ICD 10 code for transportation? However, ambulance transportation has certain risks. 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. Non-Emergent Medical Transportation (NEMT) is a Health First Colorado benefit when the member has no other means of transportation. Those circumstances involve a doctor declaring in writing in that the trip is medically necessary and a healthcare company that participates in Medicare providing the transportation. Advanced Life Support (ALS) A0427 A0433 A0425 A0424 Refer to theGeneral Provider Information manualfor general billing information. 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. The 837 Professional (837P) transaction should be utilized for electronic billing. A0426 Ambulance service, (ALS), non-emergency transport (Level 1), A0428 Basic Life Support, Non-Emergency, A0433 Advanced life support, level 2 (ALS2). Healthcare providers should record correct clinical documentation during the case for reimbursement. A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. 5. c: Only code 45385 is reported. HCPCS Level II codes are updated by CMS. Mileage shall be paid for the shortest trip length in miles as determined by an internet-based map, trip planner, or other Global Positioning System (GPS). The SDE will request the required documentation and submit to the Department for review and decision. Non-emergency medical transportation (NEMT) is an important benefit for people who need assistance getting to and from medical appointments. A facility whose primary purpose is education. XmyUq8cdij1_gvJ/U+>k\3+KC3@~ Sgj='|mm36M4 FMrEJ [[,_;+t*_SMemVEW6;pV $[.pnS|3/OvGX;+ZwGJ+fD'^ Date Patient Unable to Work in Current Occupation, 18. The AMA develops and manages CPT codes on a rigorous and . 4 0 obj Licensure, or proof of exemption from licensure requirements, must be included in the Health First Colorado NEMT provider application. 32. NEMT can only be utilized to transport eligible members to and from Health First Colorado provider service locations that are enrolled to provide the service the member is transported to receive. 10 CCR 2505-10.8.014 covers NEMT. By clicking Accept All, you consent to the use of ALL the cookies. Mobility/ambulatory vehicle transportation is a Health First Colorado benefit when the member's medical or physical condition precludes the use of member-purchased public or private transportation, or other less costly modes of Health First Colorado transportation. HCPCS are used to identify and reimburse non-emergent medical transportation services. What is the CPT code for non-emergency transportation? Providers should use HCPCS A0120 plus modifier TK (Extra member or passenger) to bill for mobility van services. This may be by stretcher, board, gurney, or other appropriate device. Patient is not located in their home when receiving health services or health related services through telecommunication technology. NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. https:// If an exception is made, the SDE must document the reason and can pay mileage for the actual route traveled. MedicalBillersandCoders.com is a professional medical billing company, with over 2 decades years of experience. 3 0 obj (Effective January 1, 2020). But an emergency medical technician (EMT) may be the primary provider on prehospital ambulance transport. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. Necessary cookies are absolutely essential for the website to function properly. The following contains a list of valid modifiers. Taxicab 32- Service Facility Location Information. Providers in the state-contracted broker service area must be enrolled in the broker's network in order to provide services and receive payment for covered services. transportation is also excluded even if the beneficiary could only have gone by ambulance. Enter the number of units provided for each procedure code. 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. The series of local procedure codes used to bill for mobility van services (X6022-X6030) are no longer available. Heres how you know. Web Portal example of a member eligible for NEMT services: If the member has only QMB coverage without the "Medicaid state plan", the member is not eligible for NEMT services. There are seven categories of ground ambulance services which include both land and water transportation. The only exceptions to these provider requirements are reimbursements or mileage paid to members, members' family, members' friends, or volunteers for covered services, and commercial air, train, and bus tickets. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. The transportation services must be medically necessary and provided within the scope of the provider's certification and/or license. Health First Colorado accepts the CMS place of service codes. 3. a: HCPCS Level II A codes are used to report transportation services, including ambulance. Member Contact Center1-800-221-3943/State Relay: 711. Note: If services provided are emergency, the Emergency Indicator field (Box 24C) on the CMS-1500 claim form must be checked or condition code 81 (emergency indicator) on the UB-04 claim form must be included. MBC caters to Clinics, Hospitals, and Providers in more than 40 specialties to enhance profitability and boost revenue. The decision will be communicated to the SDE. To provide Non-Medical Transportation (NMT) services, a separate enrollment application is necessary to submit claims for NMT services. lock A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services. Other Insured's Policy or Group Number. Our resources for providers explain important guidelines such as the difference between emergency and non-emergency medical transportation, accepted types of transportation, the types of transportation service delivery systems, and driver and vehicle acceptance criteria. If there is no signature on file, leave blank or enter "No Signature on File". The diagnosis must be referenced to each detail line by placing a "1" in the diagnosis indicator field. Ancillary services include: Public/Mass Transportation Use the appropriate number of units to identify the actual number of riders. The CPT coding system offers doctors across the country a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency. endobj An official website of the United States government What are the CPT codes for ambulance transportation? National Codes Established for State Medicaid Agencies T1000-T5999 Transportation Services T2001-T2007 Non-emergency transportation; patient attendant/escort T1999 T2001 T2002 HCPCS Code for Non-emergency transportation; patient attendant/escort T2001 This will ensure the correct interpretation of the type of means of transport. Emergency Medical Transportation (EMT) regulations allow inter-facility transfers between hospitals to be billed as EMT services. Service. CPT code A0428: Ambulance service, basic life support, and non-emergency transportation are all available in this code mentioned above. In this case, the mobility /ambulatory vehicle must also meet PUC requirements for mobility vehicle services and agrees to the Health First Colorado reimbursement for mobility/ambulatory vehicles. All rules and practices for in-state NEMT apply to travel for routine medical services provided to members in Colorado border communities performed across the state line in a Border Town/City indicated in Appendix F because of closer proximity to the closest qualified provider. 13. <> The cookie is used to store the user consent for the cookies in the category "Other. Charges incurred while the member is not in the vehicle, except for lodging and meals. Clarified interfacility transfers, 9-1-1 response calls, and unit limits for ancillary services. Ambulance means any publicly or privately-owned vehicle that is specially designed, constructed, modified or equipped to be used, maintained and operated on streets or highways to transport clients to a hospital or other treatment facility in cases of accident, trauma or severe illness.