New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 50 - TRANSPORTATION SERVICES MANUAL
Subchapter 1 - GENERAL PROVISIONS
Section 10:50-1.6 - Reimbursement policy for emergency transportation services
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The least expensive mode of emergency transportation suitable to the Medicaid/NJ FamilyCare fee-for-service beneficiary's needs shall be used.
(b) Mileage for ground ambulance service shall be measured by odometer from the point at which the Medicaid/NJ FamilyCare fee-for-service beneficiary enters the vehicle to the point at which he or she exits the vehicle.
(c) For emergency trips by ground ambulance in excess of 15 miles one way, loaded mileage is reimbursable beginning with the first mile, at a higher rate as indicated at N.J.A.C. 10:50-2, Healthcare Common Procedure Coding System (HCPCS). The higher rate of reimbursement is applicable both to the one-way trip and to the return/round trip.
(d) There is no reimbursement for waiting time on round trips, and it is limited to a maximum of one hour on one-way trips at the point of destination, not at the point of departure.
(e) Emergency transportation service provided to a Medicaid/NJ FamilyCare fee-for-service beneficiary is reimbursable by the New Jersey Medicaid/NJ FamilyCare program under the following conditions only:
(f) Reimbursement shall not be permitted when a Medicaid/NJ FamilyCare fee-for-service beneficiary is transported under the following conditions:
(g) For ambulatory individuals, if other modes of transportation are appropriate or available, Medicaid/NJ FamilyCare fee-for-service beneficiaries do not qualify for ambulance service. The appropriate Medicaid/NJ FamilyCare-reimbursed modes of transportation service for ambulatory individuals, in most cases, are public transportation, livery, clinic van, taxicab, bus, or county-administered, lower modes of service.
(h) Air ambulance (rotary wing) reimbursement shall be based on a rate authorized by the Division of Medical Assistance and Health Services, not to exceed the charge made to non-Medicaid/NJ FamilyCare beneficiaries for the same service.
(i) Hospital-based transportation service provided to a Medicaid/NJ FamilyCare fee-for-service beneficiary shall be recognized by the Division as a covered outpatient hospital service under the conditions set forth in the hospital services rules, specifically N.J.A.C. 10:52-2.16.
(j) When an independent transportation provider renders a round trip service to a Medicaid/NJ FamilyCare fee-for-service beneficiary in a general hospital whose status remains "inpatient," the independent transportation provider bills the hospital for the service.
(k) If a nursing facility transports a Medicaid/NJ FamilyCare fee-for-service beneficiary, reimbursement is considered as part of the per diem rate. No further reimbursement is allowed.
(l) No additional payment is made for the use of medical supplies and/or equipment. Exception: Oxygen is reimbursable on a per occurrence basis when provided to a Medicaid/NJ FamilyCare fee-for-service beneficiary during an ambulance trip.
(m) If a transportation service is operated by an organization which has established a policy of providing service without cost for a specific class of individuals, or individuals living within a given area, then it shall be understood that such service is also available without cost to individuals falling within such category who are covered under the New Jersey Medicaid/NJ FamilyCare program.
(n) A transportation company shall not charge the New Jersey Medicaid/NJ FamilyCare fee-for-service program a higher rate than the rate charged by the transportation company to provide similar service to private-pay, non-New Jersey Medicaid/NJ FamilyCare-covered individuals.
(o) Mileage shall be reimbursed in full miles only. Distances of .4 miles or less shall be rounded down to the last full mile and distances of .5 miles or greater shall be rounded up to the next full mile for reimbursement purposes.