Current through Register Vol. 50, No. 9, September 20, 2024
A. Levels of
Care. Transportation by ground ambulance has been determined to be of two
levels of care: either basic life support (BLS) or advanced life support (ALS).
The ALS level of care cannot be charged unless the services meet the
requirements stated in the ALS definition below. The BLS level of care will be
billed when the ALS level of care does not apply.
B. Definitions
1. Advanced Life Support. The advanced life
support (ALS) base rate may be billed when the following requirements are met.
For the trip being billed, at least one ALS service must have been provided.
ALS services are defined as:
a.
administration of intravenous solutions by an emergency medical
technician;
b. airway management by
an emergency medical technician or paramedic;
c. endotracheal airway management by an
emergency medical technician or paramedic;
d. advanced cardiac life support performed by
a paramedic;
e. administration of
drugs by a paramedic; and
f.
performance of any of the above by a registered nurse or physician.
2. Basic Life Support. The basic
life support (BLS) base rate is applicable to ground ambulance transports not
covered under the ALS definition above.
C. Covered Services. For the two types of
ambulance transportation services, vendors will be reimbursed at a base rate
plus mileage. The base rate includes all charges for the ambulance
transportation service not otherwise listed as a covered HCPCS code.
Reimbursable services are detailed in §3911, "Schedule of Maximum
Allowances."
1. Emergency Situations. The
carrier/self-insured employer will reimburse ambulance service from the scene
of the accident to the hospital or from some other location in the event an
emergency exists.
2. Nonemergency
Transports. Nonemergency transports may be allowed when the claimant's medical
or physical condition precludes use of other modes of transportation, or if a
claimant needs to be transferred from one inpatient medical facility to another
because of specialized services. A report may be requested from the attending
physician documenting the necessity.
3. Roundtrips. Except for residents of
nursing homes or personal care homes, roundtrips are not reimbursable without
prior authorization by the carrier/self-insured employer. Unless the claimant's
physical condition will not permit, the claimant is expected to provide his/her
own transportation home after receiving treatment at a medical facility. The
carrier/self-insured employer may also reimburse roundtrips for other reasons
if prior authorization has been obtained.
4. Air Transport. Air ambulance
transportation services will be reimbursed when specialized emergency services
are not available locally or when ground transportation would be a clear health
or life-endangering alternative. When prior authorization has been obtained,
nonemergency air transportation may be reimbursed.
D. Noncovered Services
1. Routine, nonemergency ambulance or
emergency vehicle transports to the doctor, therapist or other medical
practitioner because of a lack of transportation on the part of the claimant
are not covered unless pre-authorized by the carrier/self-insured
employer.
2. The advanced life
support (ALS) base rate will not be reimbursed simply because an ambulance is
"ALS equipped" or because specially trained personnel were present. The ALS
transport must have been medically justified. The nature of the injury or
illness must be described in the diagnosis field of the invoice for all ALS
transports or the bills will be denied pending receipt of the required
information, or reimbursed at a lesser level of care. Documentation should also
be attached to invoices when billing for BLS transports.
3. Only loaded transport mileage is
reimbursable. Return mileage on one-way transports is not reimbursable and
should not be billed to the carrier/self-insured employer.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
23:1034.2.
