Mich. Admin. Code R. 418.10926 - Billing for air and ground ambulance services
Rule 926.
(1)
Air ambulance providers shall bill procedure codes A0430, A0431, A0435, and
A0436 as appropriate from the HCPCS codebook, as adopted by reference in
R 418.10107.
(2) Ground ambulance providers shall bill
procedure codes A0425-A0429 and A0432-A0434 as appropriate from the HCPCS
codebook, as adopted by reference in
R 418.10107.
(3) A hospital-owned air or ground ambulance
provider billing with the same tax identification number as the hospital shall
submit charges for ambulance services on a UB-04 form. All other ambulance
providers shall submit charges for ambulance services on a CMS-1500
form.
(4) Air ambulance services
are considered reasonable when a medical condition, in whole or in part, is
such that transportation by either basic or advanced life support ground
ambulance would constitute a threat to the patient's life or seriously endanger
the patient's health.
(5) Ground
ambulance services are considered reasonable when a medical condition is such
that use of other forms of transportation are contraindicated and would
endanger the patient's health.
(6)
A properly submitted air or ground ambulance bill shall include documentation
indicating the necessity of air or ground ambulance services.
(7) An air ambulance service shall be covered
only to the nearest facility capable of furnishing the required level and type
of care for the injury or illness involved.
(8) The ambulance point of pick up shall be
reported by its 5-digit ZIP code. Charges for services and mileage shall be
based on documented loaded patient mileage only. If the patient is pronounced
dead by a legally authorized professional after the air ambulance has taken off
or the ground ambulance is dispatched, but before being loaded onto the
ambulance for transport, then the MAP is the appropriate base rate, with no
amount allowed for mileage or for a rural adjustment.
(9) Ambulance origin and destination
modifiers listed in the HCPCS Level II codebook, as adopted by reference in
R 418.10107, shall be used on the
bill as appropriate and will be listed on the agency website at
www.michigan.gov/wca.
(10) All items and services associated with
the ambulance transport are included in the maximum allowable payment and shall
not be unbundled and billed separately.
(11) Ground ambulance services are reimbursed
based on the level of services performed, not the type of vehicle
responding.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.