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Ambulance Services

General Information

Ambulance Services are nonemergency and emergency patient transports that are reimbursed by Texas Medicaid. These services include out-of-hospital acute medical care, transport to definitive care, and other medical transport to patients with illnesses and injuries which prevent the patients from transporting themselves. To enroll in the Texas Medicaid Program, ambulance providers must operate according to the laws, regulations, and guidelines governing ambulance services. More information about these services may be found in the Ambulance Services Handbook portion of the Texas Medicaid Provider Procedure Manual located on the Texas Medicaid and Healthcare Partnership (TMHP) website.

Reporting Information

Contacts

Note: Rate Analysis staff can assist you with questions concerning only payment rates for the specified services. They are not able to answer other types of questions, such as the status of payment for services rendered or questions involving eligibility for care services.

If you have questions regarding Ambulance Services fee for service payment rates, please call the Rate Analyst on the Contacts List.

If you have questions regarding Ambulance Supplemental payments program, please call the Rate Analyst on the Contacts List.

If you have questions regarding Ambulance Services program/policy issues, please call the TMHP Contact Center on the Contacts List.

Methodology / Rules

The Ambulance Services program rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 9, Rule 1111, 1113, and 1115.

Reimbursement rules applicable to Ambulance Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 5, Rule 8081 and Division 31, Rule 8600.

The fee schedules and any periodic adjustment(s) to the fee schedules are published in banner messages contained in provider Remittance and Status (R&S) reports, Medicaid Bulletin articles, web postings, provider manual, fee schedules or other provider notification.

Ambulance Supplemental Payment Program

General Information

Governmental ambulance providers may receive a supplemental payment if the governmental ambulance provider's allowable costs exceed the fee-for-service revenues received during the same period. An approved ambulance provider that meets the required enrollment criteria may receive supplemental payments up to reconciled costs with the submission of an annual cost report. Cost reports will be based on a cost to billed charge ratio methodology.

Eligibility for Ambulance Supplemental payment program

A governmental ambulance provider must submit a written request for a supplemental payment by regular mail or special mail delivery to the HHSC Rate Analysis Department. The request, if acceptable, will be effective the first day of the month after the request is approved.

View the Application Request Criteria

Notices

View a list of important notices regarding the Ambulance Supplemental Payment Program (ASPP)

Payment Rate Information

Payment rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid & Healthcare Partnership (TMHP) website (see Fee Schedules).

Training Information

View the Cost Report Training information

Contact Rate Analysis

Send email to Rate Analysis


Updated: November 26, 2013