Section 405 IAC 5-30-1.5 - Reimbursement rates for transportation servicesAuthority: 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.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-405130241RFAReadopted filed 11/13/2019, 11:54 a.m.: 20191211-IR-405190487RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA