37.86.2604    AMBULANCE SERVICES, COVERAGE AND BILLABLE SERVICES

(1) Except as provided in (2), the base charge specified in the department's fee schedule referred to in ARM 37.86.2605 for both basic life support (BLS) and advanced life support (ALS) ambulance services includes charges for all personnel, reusable supplies and capital equipment. This includes:

(a) The driver and attendants, including extra attendants;

(b) Nurse, physician, or nonambulance personnel in ambulance;

(c) All services provided by the personnel such as:

(i) CPR and defibrillation;

(ii) monitoring of pulse oximeter;

(iii) monitoring of vital signs;

(iv) EKG monitoring;

(v) IV and drug therapy;

(vi) intubation; and

(vii) glucometer check.

(d) ALS director;

(e) Reusable supplies, including but not limited to:

(i) ambu bag (bag valve mask);

(ii) anti-shock trousers (mast pants/suits);

(iii) cervical collar (neck immobilization item), nondisposable;

(iv) CPR board;

(v) CPR pocket mask, nondisposable; and

(vi) splints, nondisposable.

(f) Capital equipment, including but not limited to:

(i) heart monitor;

(ii) defibrillator;

(iii) aspirator (see suction);

(iv) back board;

(v) pulse oximeter;

(vi) IV pumps;

(vii) special stretchers such as:

(A) scoop stretcher;

(B) plastic stretcher;

(C) spine board; and

(D) flat cot;

(viii) suction and suction equipment;

(ix) glucometer;

(x) compressor; and

(xi) nebulizer.

(g) Billing charges;

(h) Decontamination of ambulance;

(i) Emergency charge;

(j) Night charge;

(k) Transporting of portable EKG to facility or location; and

(l) Waiting time.

(2) The following are not included in base rates for BLS and ALS and are separately billable:

(a) Mileage is allowed in addition to the base rate when the patient is transported to the nearest appropriate facility.

(i) charges for mileage must be based on loaded mileage only, i.e., from the pickup of a patient to their arrival destination; and

(ii) air ambulance mileage rate is calculated per actual loaded, patient onboard, miles flown and is expressed in statute miles, not nautical miles.

(b) EKG services (the technical component for obtaining tracing only, no interpretation and report) are reimbursable as a separate service for BLS, ALS and air ambulance. The reimbursement includes all EKG supplies.

(i) this service is allowed one time per transport;

(ii) reimbursement under this code includes the following:

(A) EKG paper;

(B) electrodes; and

(C) quick patch, fast patch, etc.

(c) Defibrillation disposable supplies are for supplies used when a patient is actually defibrillated. Reimbursement includes the following:

(i) lubricant/conduction gel;

(ii) wet saline gauze;

(iii) disposable electrodes;

(iv) all disposable supplies used with defibrillation; and

(v) quick patch, fast patch, etc.

(d) Routine disposable, nonreusable supplies may be covered and reimbursed separately from the ambulance base rate. A service is allowed as a one time charge per transport and includes the following supplies:

(i) bandages/dressings;

(ii) gauze/4x4s, etc.;

(iii) CPR pocket mask;

(iv) restraints;

(v) gloves;

(vi) linens (disposable);

(vii) tape;

(viii) emesis basin;

(ix) urinal;

(x) needles and syringes;

(xi) alcohol wipes;

(xii) hot/cold packs;

(xiii) elastic bandages;

(xiv) splints (disposables);

(xv) sterile water or saline for irrigation;

(xvi) chemstrips;

(xvii) disposable cervical collar;

(xviii) disposable ambu bag; and

(xix) disposable suction supplies (NC tube, tubing, canister, etc.).

(e) IV drug therapy disposable supplies may be reimbursed separately only if they are medically necessary as documented in the trip report. No payment will be made for IV supplies when they are provided merely on the basis of ambulance protocol.

(i) This service is allowed one time per transport.

(ii) Reimbursement for this service includes the following:

(A) all needles/catheters (angiocath, etc.);

(B) all IV tubing (micro, macro and specialized);

(C) tape;

(D) alcohol wipes;

(E) betadine or other antiseptic agents;

(F) filters;

(G) IV start kits;

(H) needles and syringes; and

(I) all dressings.

(f) Drugs may be reimbursed separately only if they are medically necessary as documented in the trip report.

(i) Injectable drugs and IV solutions administered in an emergency situation during the course of a covered ambulance trip are covered as nonreusable supplies. The medical necessity of such drugs and IV solutions and the need to administer them during transport must be clearly documented.

(g) Oxygen and oxygen supplies may be reimbursed separately only if they are medically necessary as documented in the trip report. No payment will be made for oxygen or oxygen supplies when they are provided merely on the basis of ambulance protocol.

(i) This service is allowed per 1/2 hour of oxygen usage per transport.

(ii) Reimbursement includes:

(A) oxygen;

(B) disposable oxygen supplies such as:

(I) cannulas;

(II) masks;

(III) tubing (extension, etc.);

(IV) humidifier;

(V) flow meter; and

(VI) nebulizers.

(iii) The administration of oxygen itself does not satisfy the requirement that a patient needs oxygen. If the patient travels for any other reason (e.g., church, grocery store, shopping, etc.) with portable oxygen, then they are not a candidate for ambulance transportation solely because of their oxygen requirement.

(h) Esophageal intubation may be reimbursed when establishing or maintaining an open airway but is not reimbursable for administering oxygen only.

(i) reimbursement for esophageal intubation includes the following:

(A) ET tube/NT tube;

(B) tape;

(C) gloves;

(D) bite mouthpiece;

(E) all airways (oral, esophageal, nasal, etc.);

(F) disposable ambu bag; and

(G) disposable airway suction equipment (suction catheters, tips, tubing, and canister).

History: 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 2001 MAR p. 1183, Eff. 7/6/01.