Section 471-4-005 - BILLING AND PAYMENT FOR AMBULANCE SERVICES005.01BILLING.005.01(A)GENERAL BILLING REQUIREMENTS. Providers must comply with all applicable billing requirements codified in 471 NAC Chapter 3. In the event that individual billing requirements in 471 NAC 3 conflict with billing requirements outlined in this chapter 4, the individual billing requirements in this chapter 4 will govern.005.01(B)SPECIFIC BILLING REQUIREMENTS.005.01(B)(i)BILLING INSTRUCTIONS. The provider must bill Medicaid using the appropriate claim form or electronic format.005.01(B)(ii)USUAL AND CUSTOMARY CHARGE. The provider or the provider's authorized agent must submit the provider's usual and customary charge for each procedure code listed on the claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) procedure codes used by Medicaid are listed in the Nebraska Medicaid Practitioner Fee Schedule. 005.02PAYMENT.005.02(A)GENERAL PAYMENT REQUIREMENTS. Medicaid will reimburse the provider for services rendered in accordance with the applicable payment regulations codified in 471 NAC 3. In the event that individual payment regulations in 471 NAC 3 conflict with payment regulations outlined in this chapter the individual payment regulations in this chapter l will govern.005.02(B)SPECIFIC PAYMENT REQUIREMENTS.005.02(B)(i)BASE RATES. Ground ambulance base rates include all services, equipment, and other costs.005.02(B)(ii)REIMBURSEMENT. Medicaid pays for covered ambulance services at the lower of:(1) The provider's submitted charge; or(2) The allowable amount for that procedure code in the Nebraska Medicaid Practitioner Fee Schedule in effect for that date of service.005.02(B)(iii)AIR AMBULANCE. If a determination is made that ambulance transport is medically necessary, but ground ambulance would have been appropriate, payment for the air ambulance service is limited to the amount allowable for ground transport.471 Neb. Admin. Code, ch. 4, § 005
Repealed effective 12/14/2016.Amended effective 5/8/2022