General Rate Provisions and Payment

(1) Rate Determination. The rates for authorized ambulance and wheelchair van services under 101 CMR 327.00 are the lowest of (a) the eligible provider's usual fee to patients other than publicly aided individuals; or (b) the eligible provider's actual charge submitted; or (c) the schedule of fees set forth in 101 CMR 327.03. (2) Allowable Trip Fees for Ambulance Services. Code Allowable Fee Description of Code IC Transportation ancillary; parking fees, tolls, other (used only for ferry charges) Ground mileage, per statute mile (loaded mileage) Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1) Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 - emergency) Ambulance service, basic life support, nonemergency transport (BLS) Ambulance service, basic life support, emergency transport (BLS- emergency) $4,036.04 Ambulance service, conventional air services, transport, one way (fixed wing) $4,036.04 Ambulance service, conventional air services, transport, one way (rotary wing) Advanced life support, level 2 (ALS 2) Specialty care transport (SCT) IC Unlisted ambulance service. (Used for transporting patients who require special resources to be safely transported, including but not limited to bariatric patients.) (3) Billing Certification. Each eligible provider who submits an invoice to a governmental unit for authorized ambulance services must certify to the accuracy of the level of services provided, as listed on its invoice. (4) Allowable Trip Fees for Wheelchair Van Services. Code Allowable Fee Description of Code Nonemergency transportation; wheelchair van (each way) S0215 Nonemergency transportation; mileage, per mile (wheelchair van, loaded mileage) T2001 Nonemergency transportation; patient attendant/escort (wheelchair van, each way)