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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 AmbulanceServices for Managed Care Members Effective April 1, 2021
This notice informs providers of a change in howemergency ground ambulance services will be billed for persons covered underone of the Department’s HealthChoice Illinois (HCI) managed carehealth plans. This billing change does not apply to memberscovered 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 managedcare plans’ contracts. MCOs will cease paying any emergency ground ambulance claims with datesof service on or after April 1, 2021. Claims for emergency ground ambulanceservices must be billed directly to the Department for persons covered underone of the HCI managed care plans. MMAI managed care plans will continue coveringand paying for emergency ground ambulance services.
The service codes included in this HCI carve-out are as follows. Claimsshould 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 fornon-emergency ambulance services. These services remain the responsibility of boththe HCI and MMAI managed care plans.
Questions regarding this notice may be directed tothe Bureau of Professional and Ancillary Services at 877-782-5565 forfee-for-service issues, or to the applicable HealthChoice Illinois managed care plan.
KellyCunningham, Administrator
Divisionof Medical Programs