Orange County NC Website
Browse       Search
24 <br /> NC Medicaid Medicaid and Health Choice <br /> Ambulance Services Clinical Coverage Policy No: 15 <br /> Effective Date:January 15,2020 <br /> Attachment A: Claims-Related Information <br /> Provider(s) shall comply with the,NCTracks Provider Claims and Billing Assistance Guide,Medicaid <br /> bulletins,fee schedules,NC Medicaid's clinical coverage policies and any other relevant documents for <br /> specific coverage and reimbursement for Medicaid and NCHC: <br /> A. Claim Type <br /> Institution-based ambulance providers bill institutional(UB-04/8371) <br /> Independent/private ambulance providers bill professional(CMS-1500/837P) <br /> Unless directed otherwise,Institutional Claims must be billed according to the National Uniform <br /> Billing Guidelines.All claims must comply with National Coding Guidelines <br /> B. International Classification of Diseases and Related Health Problems, Tenth <br /> Revisions, Clinical Modification (ICD-10-CM) and Procedural Coding System (PCS) <br /> Provider(s) shall report the ICD-IO-CM and Procedural Coding System(PCS)to the highest level <br /> of specificity that supports medical necessity. Provider(s) shall use the current ICD-10 edition and <br /> any subsequent editions in effect at the time of service.Provider(s) shall refer to the applicable <br /> edition for code description, as it is no longer documented in the policy. <br /> C. Code(s) <br /> Provider(s) shall report the most specific billing code that accurately and completely describes the <br /> procedure,product or service provided. Provider(s) shall use the Current Procedural Terminology <br /> (CPT),Health Care Procedure Coding System(HCPCS), and UB-04 Data Specifications Manual <br /> (for a complete listing of valid revenue codes) and any subsequent editions in effect at the time of <br /> service. Provider(s) shall refer to the applicable edition for the code description,as it is no longer <br /> documented in the policy. <br /> If no such specific CPT or HCPCS code exists,then the provider(s) shall report the procedure, <br /> product or service using the appropriate unlisted procedure or service code. <br /> HCPCS Codes <br /> Institutional and professional providers use the following HCPCS code(s)to identify the service <br /> being rendered. <br /> HCPCS Code(s) <br /> A0425 A0430 <br /> A0426 * A0431 <br /> A0427 A0433 <br /> A0428 * A0435 <br /> A0429 A0436 <br /> T2003* <br /> * This code is not covered under the NCHC program.NCHC does not cover non-emergency <br /> ambulance transportation. <br /> 20A13 18 <br />