Medical Transportation -- Ground (mc tran gnd)

By Jean Parker,2014-08-28 13:58
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Medical Transportation -- Ground (mc tran gnd)

     mc tran gnd

    Medical Transportation Ground 1

    This section contains information on ground medical transportation services and program coverage (California Code of Regulations [CCR], Title 22, Section 51323). For additional help, refer to the Medical

    Transportation Ground: Billing Examples section in this manual.


    Program Coverage Medi-Cal covers ambulance and other medical transportation only

    when ordinary public or private conveyance is medically contra-

    indicated and transportation is required for obtaining needed medical


    Eligibility Requirements To receive reimbursement, a recipient must be eligible for Medi-Cal on

    the date of service.

2 Medical Transportation Ground Allied Health Medical Transportation June 2001

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    Transportation to Medi-Cal covers emergency ground medical transportation to the Nearest Hospital nearest hospital capable of meeting a recipient’s needs. When the

    geographically nearest facility cannot meet the needs of a recipient,

    transportation to the closest facility that can provide the necessary

    medical care is appropriate under Medi-Cal. Coverage will be

    jeopardized if a recipient is not transported to the nearest acute

    hospital capable of meeting a recipient’s emergency medical needs

    (contract or non-contract).

    Note: In non-emergency situations, physicians and hospitals must

    adhere to hospital contract regulations and admit recipients to

    the nearest contract hospital.

    Transportation to a Recipients transported to a non-contract hospital must be taken to the Second Facility nearest contract hospital as soon as they are stable. Recipients are

    considered stable for transport when they are able to sustain transport

    in an ambulance staffed by an Emergency Medical Technician I

    (EMT I) with no expected increase in morbidity or mortality as a result

    of the transportation. In addition, if a recipient is an infant, the

    ambulance must have necessary modular equipment.

    When the nearest facility serves as the closest source of emergency

    care and a recipient is promptly transferred to a more appropriate care

    facility, transportation from the first to the second facility is considered

    a continuation of the initial emergency trip. However, the transfer is

    not considered a continuation of the initial emergency trip if the

    provider vehicle leaves the facility to return to its place of business or

    accepts another call.

2 Medical Transportation Ground Allied Health Medical Transportation June 2001

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    Emergency Statement All emergency medical transportation requires a statement in the

    Reserved for Local Use field (Box 19) of the claim, or on an

    attachment, supporting that an emergency existed. The statement

    may be made by the provider of transportation and must include:

    ; The name of the person or agency that requested the service

    ; The nature of the emergency

    ; The name of the hospital to which a recipient was transported

    ; Clinical information on a recipient’s condition

    ; The reason the services were considered to be immediately

    necessary (medical necessity)

    ; The name of the physician accepting responsibility for the


2 Medical Transportation Ground Allied Health Medical Transportation June 2001

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    Non-Emergency Coverage Non-emergency medical transportation is covered only when a

    recipient’s medical and physical condition does not allow that recipient

    to travel by bus, passenger car, taxicab, or another form of public or

    private conveyance. Transport is not covered if the care to be

    obtained is not a Medi-Cal benefit. In addition, please see the

    Optional Benefits Exclusion section in the appropriate Part 2 manual

    for additional information on excluded optional benefits.

    Non-emergency medical transportation necessary to obtain

    medical services is covered subject to the written prescription of a

    physician, dentist or podiatrist.

Authorization A Treatment Authorization Request (TAR) is required for

    non-emergency transportation. A legible prescription (or order sheet

    signed by the physician for institutional recipients) must accompany

    the TAR.

    All TARs for non-emergency medical transportation must be

    submitted to either the Sacramento or San Diego Medi-Cal Field

    Office. See the TAR Field Office Addresses section in this manual

    for regional coverage by the appropriate Medi-Cal field office.

Inter-Facility Transport Please refer to the Evaluation and Management section of the Part 2

    Pediatric Critical Care manual for information regarding facility-to-facility transport of critically

    ill or critically injured pediatric patients (24 months of age or less) with

    an attending physician.

2 Medical Transportation Ground Allied Health Medical Transportation 408 September 2009

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    Prescription Requirements The prescription (or order sheet signed by the physician for

    institutional recipients) that is submitted with a TAR must include the


    ; Purpose of the trip

    ; Frequency of necessary medical visits/trips or the inclusive

    dates of the requested medical transportation

    ; Medical or physical condition that makes normal public or

    private transportation inadvisable

    Note: When transportation is requested on an ongoing basis,

    the chronic nature of a recipient’s medical or physical

    condition must be indicated and a treatment plan from

    the physician or therapist must be included. A diagnosis

    alone, such as “multiple sclerosis” or “stroke,” will not

    satisfy this requirement.

    The Medi-Cal field office consultant needs the above information to

    determine the medical necessity of a specialized medical transport

    vehicle and the purpose of the trip. Incomplete information will delay


2 Medical Transportation Ground Allied Health Medical Transportation June 2001

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    Transport From Acute A TAR is not required for non-emergency transportation from an acute Care Hospital to Long care hospital to a long term care facility. This is an exception to the Term Care Facility prior authorization requirement. This policy applies to transportation for

     recipients who received acute care as hospital inpatients who are

    being transferred to a Nursing Facility (NF) Level A or B.

    This service must be billed with one of the appropriate non-emergency

    transportation codes (HCPCS codes X0400 X0416). Refer to the

    Medical Transportation Ground: Billing Codes and Reimbursement

    Rates section in this manual for code descriptions and rates. Services

    billed with other non-emergency transportation codes require prior


    Note: Medi-Cal does not cover waiting time or night calls for transport

    from an acute care facility to NF-A care.

2 Medical Transportation Ground Allied Health Medical Transportation 320 June 2002

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Transportation to Adult