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7 <br /> NC Medicaid Medicaid and Health Choice <br /> Ambulance Services Clinical Coverage Policy No: 15 <br /> Effective Date: January 15, 2020 <br /> Related Clinical Coverage Policies <br /> Refer to htips://medicaid.ncdhhs.gov/for the related coverage policies listed below: <br /> 1E-7,Family Planning Services <br /> 2A-3, Out-of-State Services <br /> Information <br /> Refer to the following web sites for information: <br /> NC Medicaid Provider Services: https://medicaid.ncdhhs.gov/ <br /> OEMS Website: https://www.ncdhhs.gov/divisions/dhsr <br /> Provider Policies,Manuals and Guidelines: <br /> https://www.nctracks.nc.gov/content/public/providers/provider-manuals.html <br /> 1.0 Description of the Procedure, Product, or Service <br /> Ambulance services provide medically necessary treatment for NC Medicaid Program or NC <br /> Health Choice beneficiaries. Transport is provided only if the beneficiary's medical condition is <br /> such that the use of any other means of transportation is contraindicated. Ambulance services <br /> include emergency and non-emergency ambulance transport via ground and air medical <br /> ambulance for a Medicaid beneficiary. Ambulance services include only emergency transport via <br /> ground and air medical ambulance for a NCHC beneficiary. Refer to Subsection 4.0. <br /> 1.1 Definitions <br /> 1.1.1 Ground and Air Medical Ambulances <br /> A ground ambulance is the same as defined in l0A NCAC 13P .0102(29). In <br /> this policy, ambulance transport by either land or water vehicles may be referred <br /> to as"ground transportation."Vehicle and equipment requirements are located at <br /> l0A NCAC 13P .0207, .0208, and.0210. <br /> An air medical ambulance is the same as defined in l0A NCAC 13P .0102(5). <br /> Vehicle and equipment requirements are located at 10A NCAC 13P .0209. <br /> 1.1.2 Emergency Services <br /> 1.1.2.1 Emergency Medical Condition <br /> An emergency medical condition is defined in 42 C.F.R. 489.24(b). <br /> 1.1.2.2 Emergency and Immediate Responses <br /> An emergency response means responding immediately at the Basic <br /> Life Support(BLS) or Advanced Life Support Level 1 (ALS1) service <br /> to a 911 call or the equivalent in areas without a 911 call system. <br /> An immediate response is one in which the ambulance service begins <br /> as quickly as possible to take the steps necessary to respond to a 911 <br /> call. <br /> CPT codes, descriptors, and other data only are copyright 2018 American Medical Association. <br /> All rights reserved.Applicable FARS/DFARS apply. <br /> 20A13 1 <br />