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. SUBPART A. PRACTITIONER REIMBURSEMENT