§ 1245.52. Payment conditions.
Payment for ambulance transportation will be made subject to the following conditions:
(1) Ambulance transportation is medically necessary. For ambulance transportation to be considered medically necessary, one or more of the following conditions shall be documented in the remarks section of the Medical Services/Supplies Invoice:
(i) The patient is incapacitated as the result of injury or illness and transportation by van, taxicab, public transportation or private vehicle is either physically impossible or would endanger the health of the patient.
(ii) There is reason to suspect serious internal or head injury.
(iii) The patient requires physical restraints.
(iv) The patient requires oxygen or other life support treatment en route.
(v) Because of the medical history of the patient and present condition, there is reason to believe that oxygen or life support treatment is required en route.
(vi) The recipient requires transportation from a hospital to a nonhospital drug and alcohol detoxification facility or rehabilitation facility and the hospital has determined that the required services are not medically necessary in an inpatient facility.
(2) Free ambulance service is not accessible to the client.
(3) The client has been transported to the nearest appropriate medical facility enrolled in the MA Program or from a hospital to a nonhospital drug and alcohol detoxification facility or rehabilitation facility.
(4) The client has been transported to or from an appropriate medical facility in connection with services that are covered under the MA Program or the State-funded nonhospital drug and alcohol services under Act 152 of 1988 (P. L. 1239).
(5) The Medical Services/Supplies Invoice has been completed in accordance with the instructions in the Provider Handbook.
Authority The provisions of this § 1245.52 amended under sections 201(1) and 443.1(1) of the Public Welfare Code (62 P. S. § § 201(1) and 443.1(1)).
Source The provisions of this § 1245.52 adopted October 31, 1980, effective November 10, 1980, 10 Pa.B. 4257; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended October 18, 1991, effective October 19, 1991 and apply retroactively to August 1, 1989, 21 Pa.B. 4951; amended November 24, 1995, effective November 25, 1995, and apply retroactively to November 1, 1995, 25 Pa.B. 5241. Immediately preceding text appears at serial page (177252).
Cross References This section cited in 55 Pa. Code § 1245.54 (relating to noncompensable services and items).
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