Updated: Non-Emergency Ambulance Guideline

Date: February 25, 2020Attention: All providersUpdates include the following change: for approved requests, TCHP will include one unscheduled trip (if not already requested) per month to the authorization request to allow access to transport for unscheduled trips.Reminders: Texas Children’s Health Plan does not accept authorization requests from ambulance/medical transportation vendors for non-emergency transport. Instead, a Medicaid-enrolled provider (physician, nursing agency, or other Medicaid provider) must submit a non-emergency ambulance authorization request. Non-emergency transport is defined as ambulance transport provided for a Medicaid client to or from a scheduled medical appointment, to or from a licensed facility for treatment, or to the client’s home after discharge from a hospital when the client has a medical condition such that the use of an ambulance is the only appropriate means of transportation. How this impacts providers: Providers should ensure that requests are made by a Medicaid provider with their signature and date on the authorization request form to avoid transportation delays. The scheduled appointment dates and locations should also be included. In addition, providers may include the following codes with the prior authorization:  

A0425 (mileage)	=1 unit =1 mile if round trip multiply by 2
A0426	ALS (Advanced life support) truck (1 unit for each trip) if round trip multiply by 2
A0428	BLS (Basic Life Support) truck (1 unit for each trip) if round trip multiply by 2
A0422	Supplies for oxygen administration (1 unit for each trip) if round trip multiply by 2
A0382/A0398	Supplies for transport (1 unit for each trip) if round trip multiply by 2

  Next steps for providers: Providers should coordinate this change with their staff. Full description of the non-emergency ambulance guideline available here:https://www.texaschildrenshealthplan.org/for-providers/provider-resources/prior-authorization-informationIf you have any questions, please email Provider Network Management at:providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.