Summary
Oregon Health Authority is increasing reimbursement rates for ambulance "Treat in Place" services from $54.45 (A0998) to $420.62 (A0427 ALS1 Base Rate) for Oregon Health Plan fee-for-service members during the COVID-19 emergency, retroactive to March 18, 2020. Additionally, ambulances may now provide non-emergent transportation for COVID-19 positive or presumptive positive patients to primary/urgent care facilities.
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What to do
Action · 8 steps
01REQUIREMENTS: Immediately update billing system and ambulance provider contracts to reflect the new reimbursement rate of $420.62 for procedure code A0427 (replacing A0998 at $54.45) for all Oregon Health Plan fee-for-service "Treat in Place" calls.
02Billing team must.
03Reprocess or request adjustment of all ambulance claims for OHP fee-for-service members from March 18, 2020 forward using the increased A0427 rate.
04Update internal billing documentation and provider guidance to reflect the rate change.
05Train ambulance billing staff on new coding requirements.
06Coordinate with Coordinated Care Organizations (CCOs) to ensure they increase A0998 reimbursement to A0427 base rate as directed by OHA.
07For dual Medicare/Medicaid beneficiaries, continue billing Medicare first with Medicaid as secondary per existing coordination of benefits rules.
08Contact Mary Durrant (mary.durrant@dhsoha.state.or.us, 503-947-2634) with questions.
If missed: Failure to update billing may result in underpayment of claims or payment denials.
Codes mentioned
A0998A0427
Original notice
Provider Announcement
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Related changes
See all Oregon Health Plan changes →Reminder: Ambulance transport and reimbursement policies during the COVID-19 emergencyMediumEffective Jul 30, 2021 · PlanNotice of intent – OHA will amend the Medicaid State Plan to continue ambulance “treat in place” rates after the COVID-19 Public Health Emergency ends May 11, 2023MediumEffective May 11, 2023 · Public noticeNotice of intent — OHA proposes to update the calculation method for the fee-for-service ground emergency medical transportation (GEMT) supplemental payment for public emergency service providers in the Medicaid State Plan.MediumNo effective date · Public noticeProvider AnnouncementLowNo effective date · ProviderBrowse every Oregon Health Plan change in the policy list