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3 <br /> PHP Managed Care Ambulance Fee Schedule <br /> Rates Effective as of 7/1/2021 <br /> North Carolina has proposed a qualified directed payment to public ambulance providers(PAPS)to approximate <br /> 100%of the costs of covered services which PAPs incur in serving Medicaid and NC Health Choice beneficiaries. <br /> The State has established cost-based rates for each PAP that determined the minimum fee schedule below that <br /> shall serve as a rate floor in managed care.The table below represents draft rates effective 7/1/2021 per ambulance <br /> transport.All rates are subject to approval by the Center for Medicare and Medicaid Services. <br /> Taxonomies: 341600000X, 3416A0800X, 3416L0300X, 3416SO30OX <br /> Billable Ground Transport HCPCS Codes=A0426,A0427,A0428,A0429,A0433,T2003 <br /> Billable Air Transport HCPCS Codes =A0430,A0431 <br /> No separate reimbursement for mileage codes for Public Ambulance Providers <br /> Guide and the Medicaid and Health Choice Clinical Coverage Policies on the NC Medicaid Web site. <br /> Air Transport <br /> Ground Transport Medicaid/ <br /> Medicaid/NCHC NCHC Rate Per <br /> Public Ambulance Provider Name NPI Number Rate Per Trip Trip Effective Date End Date <br /> Alamance County EMS 1952406779 $ 500.63 N/A 7/1/2021 6/30/2022 <br /> Alexander County EMS 1568419273 $ 1,016.01 N/A 7/1/2021 6/30/2022 <br /> Allegheny County EMS 1336353317 $ 892.98 N/A 7/1/2021 6/30/2022 <br /> Anson County EMS 1770530123 $ 725.99 N/A 7/1/2021 6/30/2022 <br /> Atlantic Beach EMS(Town of) 1437106044 $ 1,651.26 N/A 7/1/2021 6/30/2022 <br /> Avery County EMS 1144213778 $ 937.84 N/A 7/1/2021 6/30/2022 <br /> Beaufort County EMS 1255780136 $ 2,159.17 N/A 7/1/2021 6/30/2022 <br /> Bertie County EMS 1356762306 $ 1,073.91 N/A 7/1/2021 6/30/2022 <br /> Bladen County EMS 1407802861 $ 547.75 N/A 7/1/2021 6/30/2022 <br /> Brunswick County EMS 1831146471 $ 958.15 N/A 7/1/2021 6/30/2022 <br /> Buncombe County EMS 1073574786 $ 614.47 N/A 7/1/2021 6/30/2022 <br /> Burke County EMS 1538291760 $ 669.88 N/A 7/1/2021 6/30/2022 <br /> Cabarrus County EMS 1609855543 $ 681.25 N/A 7/1/2021 6/30/2022 <br /> Caldwell County EMS 1639188162 $ 809.92 N/A 7/1/2021 6/30/2022 <br /> Caswell County EMS 1356378855 $ 742.36 N/A 7/1/2021 6/30/2022 <br /> Catawba County EMS 1790732550 $ 609.49 N/A 7/1/2021 6/30/2022 <br /> Cherokee County EMS 1386691152 $ 1,305.32 N/A 7/1/2021 6/30/2022 <br /> Chowan County EMS 1568544179 $ 657.26 N/A 7/1/2021 6/30/2022 <br /> Clay County EMS 1063459907 $ 1,120.83 N/A 7/1/2021 6/30/2022 <br /> Cleveland County CMS 1093752818 $ 1,099.08 N/A 7/1/2021 6/30/2022 <br /> Craven County EMS 1629015516 $ 1,062.80 N/A 7/1/2021 6/30/2022 <br /> Currituck County EMS 1265479497 $ 3,103.30 N/A 7/1/2021 6/30/2022 <br /> Dare County EMS 1144223330 $ 2,330.02 N/A 7/1/2021 6/30/2022 <br /> Davidson County EMS 1205969292 $ 610.67 N/A 7/1/2021 6/30/2022 <br /> Davie County EMS 1790728319 $ 907.10 N/A 7/1/2021 6/30/2022 <br /> Duplin County EMS 1508919069 $ 947.86 N/A 7/1/2021 6/30/2022 <br /> Durham County EMS 1437159613 $ 774.98 N/A 7/1/2021 6/30/2022 <br /> Eastern Band Cherokee 911 1134179161 $ 944.69 N/A 7/1/2021 6/30/2022 <br /> Edgecombe County EMS* 1972685584 $ 352.00 N/A 7/1/2021 6/30/2022 <br /> Forsyth County EMS 1043250350 $ 506.54 N/A 7/1/2021 6/30/2022 <br /> Franklin County 911 1942226501 $ 1,153.81 N/A 7/1/2021 6/30/2022 <br /> Gaston County EMS 1932258506 $ 588.59 N/A 7/1/2021 6/30/2022 <br /> Gates County EMS 1528444643 $ 546.60 N/A 7/1/2021 6/30/2022 <br /> Graham County EMS 1194741066 $ 1,012.31 N/A 7/1/2021 6/30/2022 <br /> Greene County EMS 1801833751 $ 570.83 N/A 7/1/2021 6/30/2022 <br /> Greenville City EMS 1851390553 $ 406.25 N/A 7/1/2021 6/30/2022 <br />