Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.09-022 - Provider Manual Update Transmittal #123 - Transportation

Universal Citation: AR Admin Rules 016.06.09-022

Current through Register Vol. 49, No. 9, September, 2024

Section IITransportation

251.100 Ground Ambulance Mileage

Ground ambulance providers must use procedure code A0425 to claim mileage for ground ambulance transportation, regardless of licensure level of the provider or transporting ambulance. Mileage must be rounded to the nearest mile. Actual ground ambulance mileage should be documented on the ambulance provider's patient care report.

252.100 Ambulance Procedure Codes

A0382

A0390

A0398

A0422

A0425

A0426

A0427

A0429

J0150*

J0170*

J0280*

J0460*

J1094*

J1100*

J1160*

J1200*

J1265

J1940*

J2060*

J2175*

J2270*

J2310*

J2550*

J2560*

J3360*

J3410*

J3475*

J3480*

J3490*

93041*

*Procedure code can be billed only in conjunction with procedure code A0427.

Procedure Code

Required Modifier

Description

A0422

U1

Emergency, oxygen, helicopter air ambulance

A0425

Ground mileage per statute mile.

A0428

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

A0431

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

A0434

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

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.)

A0436

Emergency, per mile, loaded, helicopter air ambulance

T2002**

Non-emergency ground ambulance transportation, hospital to nursing facility

"Procedure code must be billed on a paper CMS-1500 claim form with the supporting documentation listed in section 213.100.

Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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