Per-mile charge for out-of-state ambulance transport billed to Medicaid

This code represents the per-mile charge for ambulance transport services provided to a Medicaid beneficiary when the transport originates or terminates outside the state where the ambulance provider is primarily licensed. It specifically covers the mileage component of an out-of-state ambulance trip, distinct from the base rate.

Utilize this code when billing Medicaid for the mileage portion of an ambulance transport that crosses state lines. This applies to situations such as inter-facility transfers where the receiving facility is in an adjacent state, or emergency transports where the closest appropriate facility is out-of-state. Documentation must clearly indicate the origin and destination addresses, the medical necessity for out-of-state transport, and the total miles traveled.

• This code is for mileage only; ensure the appropriate base rate code for ambulance transport is also reported.
• Verify state-specific Medicaid policies regarding out-of-state ambulance services, as coverage and reimbursement rules can vary.
• Accurate mileage calculation is crucial; round up to the nearest whole mile for billing purposes.