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Provider Notice Issued 03/05/2021

 

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​


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