CHARGING FOR ADVANCED EMT PROCEDURES

 There has been a great deal of discussion regarding the proper billing rates that should be used for Advanced EMT Procedures. Indiana was one of the first States to train EMT’s to the Advanced EMT level which included some procedures that were classified as an Advanced Life Support Skill.  Because of this many providers charged Medicare for transports that involved IV starts and other procedures at the ALS level. When the Ambulance Fee Schedule was implemented the ability to charge ALS for these services was placed in jeopardy.  Recently, the State of Indiana made some changes that reclassified Advanced EMT at a basic level.  The State did not want to negatively impact the reimbursement for Advanced EMT providers so they sought an opinion from the CMS Regional Office in Chicago who in-turn consulted with The CMS Central Office.

CMS responded with the following:
“The Ambulance fee Schedule, implemented on April 1, 2002, refers to four categories of personnel: EMT-Basic, EMT-Intermediate, EMT-Paramedic, and Paramedic with additional training (in the context of Specialty Care Transport).  We had been describing ALS intervention as beyond an EMT-Basic, thinking that was either EMT-Intermediate or EMT-Paramedic.  Now we have learned that several states have created another level: EMT- Basic-Plus or EMT–Basic-Advanced.  We do not recognize these in the Fee Schedule and did not mean for anything less than an EMT-Intermediate to qualify for ALS.”

“So, even if States train and permit EMT-Basic to perform some procedures that are beyond the scope of an EMT-Basic, for purposes of the Ambulance Fee Schedule, they do not meet the EMT-Intermediate level.  Ambulance services performed by these staff therefore can not be billed at the ALS level.” 

Having received the response from CMS it appears to us that Advanced EMT services should be billing at the BLS level.  Not because of any changes that the State has made, but because of the fee schedule.  This recent response was from the highest source that we have been able to obtain.

PLEASE KEEP IN MIND THAT THIS IS NOT A LEGAL OPINION, THE IAA NOR THE MEMBERS OF THE REIMBURSEMENT COMMITTEE ARE ATTORNEYS AND THIS LETTER HAS NOT BEEN REVIEWED BY ANY ATTORNEY OR LAW OFFICE.
 


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