Sunday, April 10, 2016

Would insurance cover if two trips on same DOS


MO HealthNet covers transportation from the point of pickup to two different hospitals made on the same day by the same ambulance provider when it is medically necessary. This situation can occur when the ambulance transports the participant to the nearest hospital, but before the participant leaves the emergency room it is decided the first hospital is not appropriate and the participant is transported to a second hospital. When it is medically necessary to transport a participant from one hospital to another on the same date of service, providers must bill the base rate procedure code with a quantity of “2”. Mileage and any ancillary charges for both trips are to be combined.


Two emergency ambulance trips to a hospital in one day for the same participant may be covered when medically necessary. Proper trip documentation must be maintained in the participant’s record. To bill for two trips on the same day, the same provider must show a quantity of “2” units for the base rate procedure code when appropriate. Mileage and any ancillary charges for both trips are to be combined. If the base rate procedure codes aren't the same for each trip, both trips must be billed on the same claim form as separate line items with the appropriate base rate procedure codes. If two different ambulance services transport the same participant on the same date of service, both providers must maintain proper trip documentation in the participant’s record to substantiate medical necessity.

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