Indiana Administrative Code (Last Updated: December 20, 2016) |
Title 405. OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES |
Article 405IAC5. MEDICAID SERVICES |
Rule 405IAC5-30. Transportation Services |
Section 405IAC5-30-1.5. Reimbursement rates for transportation services
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5. (a) Reimbursement rates for ambulance transportation services shall be the rates listed in this subsection. Updates to covered procedure codes and rates shall be published as a provider bulletin by the office as needed. Any such updates shall be made effective no earlier than permitted under IC 12-15-13-6(a). The reimbursement rates for ambulance transportation services are as follows:
Procedure Code
Rate
A0140
Ticket Price
A0225
$160.84
A0420 U1
$20.00
A0420 U2
$20.00
A0422
$15.00
A0424
$5.00
A0425 U1
$4.41
A0425 U2
$3.31
A0426
$95.84
A0427
$160.84
A0428
$95.84
A0429
$110.84
A0430
$2,788.24
A0431
$3,172.27
A0431 QL
$3,172.27
A0433
$160.84
A0435
$8.07
A0436
$21.53
A0999
Manual Pricing
(b) Reimbursement rates for nonemergency (nonambulance) transportation services shall be the rates listed in this subsection. Updates to covered procedure codes and rates shall be published as a provider bulletin by the office as needed. Any such updates shall be made effective no earlier than permitted under IC 12-15-13-6(a). The reimbursement rates for nonemergency (nonambulance) transportation services are as follows:
Procedure Code
Rate
A0100 UA
$6.00
A0100 UB
$10.00
A0100 UC
$15.00
A0100 U4
$15.00
A0100 TK UA
$3.00
A0100 TK UB
$5.00
A0100 TK UC
$7.50
A0100 TT UA
$3.00
A0100 TT UB
$5.00
A0100 TT UC
$7.50
A0110
Ticket Price
A0130
$20.00
A0130 TK
$10.00
A0130 TT
$10.00
A0130 U6
$5.00
A0425 U3
$1.25
A0425 U5
$1.25
T2001
$5.00
T2003
$10.00
T2004
$5.00
T2007 U3
$4.25
T2007 U5
$4.25
(c) Notwithstanding all other provisions of this rule, the fee schedule rates listed in this section will be reduced by five percent (5%) for emergency transportation services (ambulance services) and by ten percent (10%) for nonemergency transportation services (nonambulance services). These rate reductions will be in effect for the period beginning upon the later of the effective date of LSA Document #10-792 or June 27, 2011, and continuing through June 30, 2013. (Office of the Secretary of Family and Social Services; 405 IAC 5-30-1.5; filed May 9, 2011, 3:59 p.m.: 20110608-IR-405100792FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA)