5160-15-04 Medical transportation services: reimbursement.

Transportation services provided by land ambulance, by air ambulance, or by ambulette and covered in accordance with rule 5101:3-15-03 of the Administrative Code are reimbursed as set forth in this rule.

(A) For the one-way transport of one passenger, or the first passenger of a multiple-passenger trip, the provider is reimbursed a base amount for the service and a loaded mileage amount for each mile the passenger was transported.

(1) The base amount is the lesser of either the provider's billed charge or the medicaid maximum listed in appendix DD to rule 5101:3-1-60 of the Administrative Code.

(2) The loaded mileage amount is the lesser of either the provider's billed charge or the medicaid maximum listed in appendix DD to rule 5101:3-1-60 of the Administrative Code.

(B) For the one-way transport of each additional passenger of a multiple-passenger trip, the provider is reimbursed a base amount for the service.

(1) The base amount is the lesser of either the provider's billed charge or a fixed portion of the medicaid maximum listed in appendix DD to rule 5101:3-1-60 of the Administrative Code.

(a) For transport by land ambulance or by ambulette, the fixed portion for the second passenger is fifty per cent, and the fixed portion for each additional passenger thereafter is twenty-five per cent.

(b) For transport by air ambulance, the fixed portion for the second passenger and for each additional passenger thereafter is one hundred per cent.

(2) No reimbursement is made for loaded mileage.

(C) For attendant services provided in conjunction with transport by land ambulance or by ambulette, the provider is reimbursed the lesser of either the provider's billed charge or the medicaid maximum listed in appendix DD to rule 5101:3-1-60 of the Administrative Code.

(D) In billing for services, the provider must specify certain information:

(1) The most appropriate code for the base service and, where applicable, for the loaded mileage;

(2) The origin and destination of transport, where applicable;

(3) For a multi-passenger trip, whether the service was provided to the first passenger or to an additional passenger; and

(4) Any other factor necessary for the correct adjudication or payment of the claim.

Replaces: 5101:3-15-04

Effective: 07/01/2008
R.C. 119.032 review dates: 07/01/2013
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 08/15/1982, 06/03/1983, 04/29/1986, 01/13/1989 (Emer), 04/13/1989, 12/01/1990, 04/01/1994, 10/01/1997, 01/01/2000, 12/27/2001, 10/01/2003, 12/30/2005 (Emer), 03/27/2006