23 Miss. Code. R. 201-1.5

Current through December 10, 2024

Rule 23-201-1.5 - Reimbursement

A. The Division of Medicaid reimburses emergency ground ambulance providers a base rate from a statewide uniform fee schedule in effect on July 1, 2021 based on one hundred percent (100%) of the rate established under Medicare on January 1, 2020:

1. For only beneficiary loaded trips,

2. For medically necessary emergency services to the closest appropriate facility for treatment, and

3. When provided in an appropriate ALS or BLS vehicle that has been licensed by the state that actually transports the beneficiary.

B. The Division of Medicaid reimburses emergency ambulance providers in addition to the base rate for the following:

1. Ground ambulance mileage to the nearest appropriate facility according to the methodology described in the State Plan,

2. Air ambulance mileage to the nearest appropriate facility,

3. The actual units administered of medically necessary injectable drugs, and

4. Discarded injectable drugs that meet the requirements of Miss. Admin. Code Part 201, Rule 1.3.F.

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.

23 Miss. Code. R. 201-1.5

Miss. Code Ann. §§ 43-13-117, 43-13-121.

Amended 12/1/2016

Amended 8/1/2018

Amended 10/1/2020

Amended 7/1/2021

Amended 5/1/2023