Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-076 - Transportation Update Transmittal #86

93041*

A0380

A0382

A0390

A0398

A0422

A0426

A0427

A0429

J0150*

J0170*

J0280*

J0460*

J1094*

J1100*

J1160*

J1200*

J1940*

J2060*

J2175*

J2270*

J2310*

J2550*

J2560*

J3360*

J3410*

J3475*

J3480*

J3490*

Q4076*

Procedure Code

Required Modifier

Description

A0436

Emergency, per mile, loaded, helicopter air ambulance

A0422

U1

Emergency, oxygen, helicopter air ambulance

A0431

Ambulance service, emergency, basic pick-up, helicopter, one unit per day

A0428

Ambulance service, ILS intermediate transport, mileage and disposable supplies billed separately

A0380

TF

ILS mileage (per mile)

T2002**

Non-emergency ground ambulance transportation, hospital to nursing facility

A0435

U1, UB

Piston propelled fixed wing air ambulance per mile

U2, UB

Turboprop fixed wing air ambulance per mile

U3, UB

Jet (fixed wing) one unit equals one mile

U4, UB

Piston propelled fixed wing air ambulance per hour (Round to the nearest hour.)

U5, UB

Turboprop fixed wing air ambulance per hour (Round to the nearest hour.)

U6, UB

Jet (fixed wing) one unit equals one hour (Round to the nearest hour.)

A0434

Air Ventilator/Respiratory Therapist, one unit equals one hour (Round to the nearest hour.)