20110406-IR-405110190ERA Temporarily adds provisions to 405 IAC 5-30 to adopt the Medicare urban base and mileage rates for fixed wing ambulance services and to set forth a fee schedule for Medicaid transportation rates for ...  

  • TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

    Emergency Rule
    LSA Document #11-190(E)

    DIGEST

    Temporarily adds provisions to 405 IAC 5-30 to adopt the Medicare urban base and mileage rates for fixed wing ambulance services and to set forth a fee schedule for Medicaid transportation rates for emergency transportation services (ambulance services) and for Medicaid transportation rates for nonemergency transportation services (nonambulance services). Temporarily amends 405 IAC 5-30-9 to reduce rates by 10% for transportation service reimbursement to family members. Authority: IC 4-22-2-37.1(a)(19); IC 12-15-21-2; IC 12-15-21-3. Effective March 31, 2011.


    SECTION 1. (a) This SECTION is supplemental to 405 IAC 5-30.

    (b) Rates for transportation services reimbursed by Medicaid shall be as follows:

    Procedure Code  Rate  Procedure Code  Rate 
    A0140  Ticket Price  A0100 TK UC  $6.75 
    A0225  $152.80  A0100 TT UA  $2.70 
    A0420 U1  $19.00  A0100 TT UB  $4.50 
    A0420 U2  $19.00  A0100 TT UC  $6.75 
    A0422  $14.25  A0100 U4  $13.50 
    A0424  $4.75  A0100 UA  $5.40 
    A0425 U1  $4.19  A0100 UB  $9.00 
    A0425 U2  $3.14  A0100 UC  $13.50 
    A0426  $91.05  A0110  Ticket Price 
    A0427  $152.80  A0130  $18.00 
    A0428  $91.05  A0130 TK  $9.00 
    A0429  $105.30  A0130 TT  $9.00 
    A0430  $2,648.83  A0130 U6  $4.50 
    A0431  $3,013.66  A0425 U3  $1.13 
    A0431 QL  $3,013.66  A0425 U5  $1.13 
    A0433  $152.80  T2001  $4.50 
    A0435  $7.67  T2003  $9.00 
    A0436  $20.45  T2004  $4.50 
    A0999  Manual Pricing (86% of Billed Charges)  T2007 U3  $3.83 
    A0100 TK UA  $2.70  T2007 U5  $3.83 
    A0100 TK UB  $4.50     

    SECTION 2. (a) This SECTION supplements 405 IAC 5-30-9.

    (b) Reimbursement to family members for transportation services calculated under 405 IAC 5-30-9 shall be reduced by ten percent (10%).

    LSA Document #11-190(E)
    Filed with Publisher: March 31, 2011, 10:26 a.m.

    Posted: 04/06/2011 by Legislative Services Agency

    DIN: 20110406-IR-405110190ERA
    Composed: Nov 01,2016 1:08:26AM EDT
    A PDF version of this document.

Document Information

Rules:
405IAC5-30