405 IAC 5-30-1.5 - Reimbursement rates for transportation services

Authority: IC 12-15

Affected: IC 12-13-7-3; IC 12-15-6; IC 12-15-13-6

Sec. 1.5.

(a) Reimbursement rates for ambulance transportation services shall be the rates listed in this subsection. Updates to covered procedure codes and rates shall be published as a provider bulletin by the office as needed. Any such updates shall be made effective no earlier than permitted under IC 12-15-13-6(a). The reimbursement rates for ambulance transportation services are as follows:

Procedure Code	Rate
A0140	Ticket Price
A0225	$160.84
A0420 U1	$20.00
A0420 U2	$20.00
A0422	$15.00
A0424	$5.00
A0425 U1	$4.41
A0425 U2	$3.31
A0426	$95.84
A0427	$160.84
A0428	$95.84
A0429	$110.84
A0430	$2,788.24
A0431	$3,172.27
A0431 QL	$3,172.27
A0433	$160.84
A0435	$8.07
A0436 A0999	$21.53 Manual Pricing

(b) Reimbursement rates for nonemergency (nonambulance) transportation services shall be the rates listed in this subsection. Updates to covered procedure codes and rates shall be published as a provider bulletin by the office as needed. Any such updates shall be made effective no earlier than permitted under IC 12-15-13-6(a). The reimbursement rates for nonemergency (nonambulance) transportation services are as follows:

Procedure Code	Rate
A0100 UA	$6.00
A0100 UB	$10.00
A0100 UC	$15.00
A0100 U4	$15.00
A0100 TK UA	$3.00
A0100 TK UB	$5.00
A0100 TK UC	$7.50
A0100 TT UA	$3.00
A0100 TT UB	$5.00
A0100 TT UC	$7.50
A0110	Ticket Price
A0130	$20.00
A0130 TK	$10.00
A0130 TT	$10.00
A0130 U6	$5.00
A0425 U3	$1.25
A0425 U5	$1.25
T2001	$5.00
T2003	$10.00
T2004	$5.00
T2007 U3	$4.25
T2007 U5	$4.25

(c) Notwithstanding all other provisions of this rule, the fee schedule rates listed in this section will be reduced by five percent (5%) for emergency transportation services (ambulance services) and by ten percent (10%) for nonemergency transportation services (nonambulance services). These rate reductions will be in effect for the period beginning upon the later of the effective date of LSA Document #10-792 or June 27, 2011, and continuing through June 30, 2013.

Notes

405 IAC 5-30-1.5

Office of the Secretary of Family and Social Services; 405 IAC 5-30-1.5; filed May 9, 2011, 3:59 p.m.: 20110608-IR-405100792FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Readopted filed 11/13/2019, 11:54 a.m.: 20191211-IR-405190487RFA Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA