Tuesday, May 10, 2016

Ambulance billing covered CPT Codes and how much copay would be collected - Medicaid patient

BENEFITS AND LIMITATIONS

KMAP beneficiaries will be assigned to one or more benefit plans. These benefit plans entitle the beneficiary to certain services. If there are questions about service coverage for a given benefit plan, refer to Section 2000 of the General Benefits Provider Manual for information on the plastic State of Kansas Medical Card and eligibility verification.

For example, only the following emergency transportation procedure codes are covered under the MediKan program. See Appendix I of the Ambulance Provider Manual for a full listing description of services.

A0225               A0380                A0390                A0427                 A0429                          A0430
A0431              A0433                 A0434               A0435                  A0436


Covered Services

** Emergency ambulance transportation provided by Basic Life Support (BLS)/Advanced Life Support (ALS) services

** Nonemergency ambulance transportation with the exception of adult care home residents (see page 8-4) for the following:

o Discharge from hospital to residence or other less expensive care

o Trips from residence to closest available medically necessary services

o Trips from one institution to another to receive a medical service not available in the first institution

** Supplies

** Waiting Time


BENEFITS AND LIMITATIONS

Nonemergency ambulance transportation requires a copayment from the beneficiary of $3 per date of service. When procedure A0426 or A0428 is billed in conjunction with one of the other nonemergency procedure codes (such as S0215) for the same dates of services, copayment will be collected from the beneficiary only once.

Bill all services occurring on the same date on the same claim form. If multiple claims are submitted for the same date(s) of service, the $3 copayment requirement will be deducted for each claim submitted. Do not reduce the charges or balance due by the copayment amount. This reduction will be made automatically during claim processing.

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