Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 4 - AMBULANCE SERVICES
Section 471-4-005 - BILLING AND PAYMENT FOR AMBULANCE SERVICES
Universal Citation: 471 NE Admin Rules and Regs ch 4 ยง 005
Current through September 17, 2024
005.01 BILLING.
005.01(A)
GENERAL BILLING REQUIREMENTS. Providers must comply
with all applicable billing requirements codified in 471 NAC Chapter 3. In the
event that individual billing requirements in 471 NAC 3 conflict with billing
requirements outlined in this chapter 4, the individual billing requirements in
this chapter 4 will govern.
005.01(B)
SPECIFIC BILLING
REQUIREMENTS.
005.01(B)(i)
BILLING INSTRUCTIONS. The provider must bill Medicaid
using the appropriate claim form or electronic format.
005.01(B)(ii)
USUAL AND CUSTOMARY
CHARGE. The provider or the provider's authorized agent must
submit the provider's usual and customary charge for each procedure code listed
on the claim. Healthcare Common Procedure Coding System (HCPCS) and Current
Procedural Terminology (CPT) procedure codes used by Medicaid are listed in the
Nebraska Medicaid Practitioner Fee Schedule.
005.02 PAYMENT.
005.02(A)
GENERAL PAYMENT
REQUIREMENTS. Medicaid will reimburse the provider for services
rendered in accordance with the applicable payment regulations codified in 471
NAC 3. In the event that individual payment regulations in 471 NAC 3 conflict
with payment regulations outlined in this chapter the individual payment
regulations in this chapter l will govern.
005.02(B)
SPECIFIC PAYMENT
REQUIREMENTS.
005.02(B)(i)
BASE RATES. Ground ambulance base rates include all
services, equipment, and other costs.
005.02(B)(ii)
REIMBURSEMENT. Medicaid pays for covered ambulance
services at the lower of:
(1) The provider's
submitted charge; or
(2) The
allowable amount for that procedure code in the Nebraska Medicaid Practitioner
Fee Schedule in effect for that date of service.
005.02(B)(iii)
AIR
AMBULANCE. If a determination is made that ambulance transport is
medically necessary, but ground ambulance would have been appropriate, payment
for the air ambulance service is limited to the amount allowable for ground
transport.
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