C

C. The Division of Medicaid does not separately reimburse for services and items which are included in the emergency ambulance service base rate including, but not limited to: 1. Assessment of the beneficiary's condition, including vital signs, 2. Charges for professional services including, but not limited to: a) Physicians, b) Nurses, c) Emergency Medical Technicians, or d) Respiratory therapists, 3. Supplies, 4. Equipment, 5. Non-injectable drugs, 6. Crystalloid fluids and the administration thereof, and D. The Division of Medicaid does not reimburse for emergency ambulance services provided by persons or entities convicted of certain crimes as specified in state or federal law. E. The Division of Medicaid does not reimburse for an ALS ground ambulance if only BLS services are provided. The ambulance provider will be reimbursed at the BLS ground ambulance rate for services. F. The provider must indicate on the claim the usual charge or charges divided by the number of persons transported when providing emergency services to more than one (1) person in one (1) vehicle or aircraft. [Revised and moved from Miss. Admin. Code Part 201, Rule 1.2.2] G. The provider must bill the appropriate: 1. Code applicable to the service rendered, and 2. Modifier indicating the origin and destination of the trip.