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 | | |
(b) Reimbursement to family members for transportation services calculated under 405 IAC 5-30-9 shall be reduced by ten percent (10%).
Filed with Publisher: March 31, 2011, 10:26 a.m.
Posted: 04/06/2011 by Legislative Services Agency
DIN: 20110406-IR-405110190ERA
Composed: Apr 29,2024 8:06:33AM EDT
A
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