Date: March 5, 2021
To: All Medical Assistance Program Providers
Re: Change in Billing for Emergency Ground Ambulance
Services for Managed Care Members Effective April 1, 2021
This notice informs providers of a change in how
emergency ground ambulance services will be billed for persons covered under
one of the Department’s HealthChoice Illinois (HCI) managed care
health plans. This billing change does not apply to members
covered under a Medicare Medicaid Alignment Initiative (MMAI) plan.
Effective with dates of service beginning April 1,
2021, emergency ground ambulance services have been carved out from the HCI managed
care plans’ contracts. MCOs will cease paying any emergency ground ambulance claims with dates
of service on or after April 1, 2021. Claims for emergency ground ambulance
services must be billed directly to the Department for persons covered under
one of the HCI managed care plans. MMAI managed care plans will continue covering
and paying for emergency ground ambulance services.
The service codes included in this HCI carve-out are as follows. Claims
should have a “Y” indicator for emergency.
|
CPT Code
|
Description
|
|
A0427
|
Advance Life Support Base Rate
|
|
A0429
|
Basic Life Support Base Rate
|
|
A0433
|
Advance Life Support Level 2 Base Rate
|
|
A0434
|
Specialty Care/Critical Care Transport Base Rate
|
|
A0425
|
Mileage associated with an above listed emergency transport
|
|
A0422
|
Oxygen associated with an above listed emergency transport
|
There are no changes to the billing requirements for
non-emergency ambulance services. These services remain the responsibility of both
the HCI and MMAI managed care plans.
Questions regarding this notice may be directed to
the Bureau of Professional and Ancillary Services at 877-782-5565 for
fee-for-service issues, or to the applicable HealthChoice Illinois managed care plan.
Kelly
Cunningham, Administrator
Division
of Medical Programs
