La. Admin. Code tit. 40 § I-3909

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-3909 - Ambulance Services

A. Levels of Care. Transportation by ground ambulance has been determined to be of two levels of care: either basic life support (BLS) or advanced life support (ALS). The ALS level of care cannot be charged unless the services meet the requirements stated in the ALS definition below. The BLS level of care will be billed when the ALS level of care does not apply.

B. Definitions

1. Advanced Life Support. The advanced life support (ALS) base rate may be billed when the following requirements are met. For the trip being billed, at least one ALS service must have been provided. ALS services are defined as:

a. administration of intravenous solutions by an emergency medical technician;

b. airway management by an emergency medical technician or paramedic;

c. endotracheal airway management by an emergency medical technician or paramedic;

d. advanced cardiac life support performed by a paramedic;

e. administration of drugs by a paramedic; and

f. performance of any of the above by a registered nurse or physician.

2. Basic Life Support. The basic life support (BLS) base rate is applicable to ground ambulance transports not covered under the ALS definition above.

C. Covered Services. For the two types of ambulance transportation services, vendors will be reimbursed at a base rate plus mileage. The base rate includes all charges for the ambulance transportation service not otherwise listed as a covered HCPCS code. Reimbursable services are detailed in §3911, "Schedule of Maximum Allowances."

1. Emergency Situations. The carrier/self-insured employer will reimburse ambulance service from the scene of the accident to the hospital or from some other location in the event an emergency exists.

2. Nonemergency Transports. Nonemergency transports may be allowed when the claimant's medical or physical condition precludes use of other modes of transportation, or if a claimant needs to be transferred from one inpatient medical facility to another because of specialized services. A report may be requested from the attending physician documenting the necessity.

3. Roundtrips. Except for residents of nursing homes or personal care homes, roundtrips are not reimbursable without prior authorization by the carrier/self-insured employer. Unless the claimant's physical condition will not permit, the claimant is expected to provide his/her own transportation home after receiving treatment at a medical facility. The carrier/self-insured employer may also reimburse roundtrips for other reasons if prior authorization has been obtained.

4. Air Transport. Air ambulance transportation services will be reimbursed when specialized emergency services are not available locally or when ground transportation would be a clear health or life-endangering alternative. When prior authorization has been obtained, nonemergency air transportation may be reimbursed.

D. Noncovered Services

1. Routine, nonemergency ambulance or emergency vehicle transports to the doctor, therapist or other medical practitioner because of a lack of transportation on the part of the claimant are not covered unless pre-authorized by the carrier/self-insured employer.

2. The advanced life support (ALS) base rate will not be reimbursed simply because an ambulance is "ALS equipped" or because specially trained personnel were present. The ALS transport must have been medically justified. The nature of the injury or illness must be described in the diagnosis field of the invoice for all ALS transports or the bills will be denied pending receipt of the required information, or reimbursed at a lesser level of care. Documentation should also be attached to invoices when billing for BLS transports.

3. Only loaded transport mileage is reimbursable. Return mileage on one-way transports is not reimbursable and should not be billed to the carrier/self-insured employer.

La. Admin. Code tit. 40, § I-3909

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.