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Public Notice: Ambulance Rates Effective January 1, 2021

Department of Health Services (DHS)

Related to: Adjustment to medicaid fee-for-service ambulance rates

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PUBLIC NOTICE
Department of Health Services
Adjustment to Medicaid Fee-for-Service Ambulance Rates: Effective January 1, 2021
The Wisconsin Department of Health Services (DHS) Division of Medicaid Services (DMS) will be implementing a rate adjustment to fee-for-service ambulance Medical Assistance (MA) maximum fee rates, effective January 1, 2021. Fee-for-service ambulance MA maximum fee rates were last adjusted in Calendar Year 2004.
The impacted ambulance fee-for-service procedure codes are listed below:
January 1, 2021 Ambulance Rates Adjustment (Does NOT include Calendar Year 2021 inflation)
HCPCS
HCPCS Description
Current MA Max Fee Rate (CY2004)
Current Medicare Base Rate (CY2020)
New MA Max Fee w/ CY2020 Rates
A0225
NEONATAL EMERG TRANSPORT
$ 308.42
No Rate
$ 387.76
A0380
BASIC LIFE SUPPORT MILEAGE
$ 5.56
No Rate
$ 6.99
A0382
BASIC SUPPORT ROUTINE SUPPLS
$ 14.73
No Rate
$ 18.52
A0384
BLS DEFIBRILLATION SUPPLIES
$ 14.73
No Rate
$ 18.52
A0390
ADV LIFE SUPPORT MILEAGE
$ 5.56
No Rate
$ 6.99
A0392
ALS DEFIBRILLATION SUPPLIES
$ 30.30
No Rate
$ 38.09
A0394
ALS IV DRUG THERAPY SUPPLIES
$ 25.25
No Rate
$ 31.75
A0396
ALS ESOPHAGEAL INTUB SUPPLS
$ 25.25
No Rate
$ 31.75
A0398
ALS ROUTINE DISPOSBLE SUPPLS
$ 14.73
No Rate
$ 18.52
A0420
AMBULANCE WAITING 1/2 HR
$ 23.03
No Rate
$ 28.95
A0422
AMBULANCE 02 LIFE SUSTAINING
$ 14.73
No Rate
$ 18.52
A0424
EXTRA AMBULANCE ATTENDANT
$ 23.03
No Rate
$ 28.95
A0425
GROUND MILEAGE
$ 1.75
$ 7.47
$ 5.98
A0426
ALS 1
$ 113.88
$ 231.98
$ 185.58
A0427
ALS1-EMERG
$ 180.31
$ 231.98
$ 185.58
A0428
BLS
$ 94.90
$ 231.98
$ 185.58
A0429
BLS-EMERG
$ 151.84
$ 231.98
$ 185.58
A0430
FIXED WING AIR TRANSPORT
$ 2,254.66
$ 3,147.91
$ 2,518.33
A0431
ROTARY WING AIR TRANSPORT
$ 2,621.38
$ 3,659.92
$ 2,927.94
A0433
ALS 2
$ 260.97
$ 231.98
$ 185.58
A0434
SPECIALTY CARE TRANSPORT
$ 308.42
$ 231.98
$ 185.58
A0435
FIXED WING AIR MILEAGE
$ 6.64
$ 8.93
$ 7.14
A0436
ROTARY WING AIR MILEAGE
$ 17.69
$ 23.83
$ 19.06
A0999
UNLISTED AMBULANCE SERVICE
$ 20.20
No Rate
$ 25.40
The calculated Calendar Year 2020 rates outlined above do not include the Calendar Year 2021 Medicare and Medicare economic index (MEI) rates of inflation. Calendar Year 2021 Medicare and MEI rates will become available in December 2020. The rates for Calendar Year 2020 will be adjusted to Calendar Year 2021 rates as soon as Medicare and MEI rates are made available. All rates with the exception of procedure codes A0433 and A0434 will increase from the current MA maximum fee schedule.
Fiscal Impact
It is estimated that in Federal Fiscal Year 2021 these changes to the fee-for-service ambulance MA maximum fee rates will result in increased annual net expenditures estimated at $3,317,160 all funds (AF), composed of $1,279,208 state funds/general purpose revenue (GPR) and $2,037,953 federal match (FED). In Federal Fiscal Year 2022, the anticipated expenditures are estimated at $15,316,529 AF, $6,144,991 GPR and $9,171,537 FED.
Copies of Changes
Copies of the state plan change may be obtained free of charge by calling or writing as follows:
Mail:
Laura Brauer
Bureau of Benefits Policy
Division of Medicaid Services
P.O. Box 309
Madison, WI 53701-0309
Phone:
(608) 266-5368
Fax:
(608) 266-1096
Attention: Laura Brauer
E-Mail:
DHSDMSSPAPublicFeedback@dhs.wisconsin.gov
Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.
Written Comments
Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e‑mail, or regular mail to the Division of Medicaid Services as described above. All written comments will be reviewed and considered.
Because the State Office Building at 1 West Wilson Street, Madison, Wisconsin is currently closed to the public, written comments will not be available for in person public review. Requests to review written comments received may be submitted to the Division of Medicaid Services as described above. Revisions may be made in the proposed changed methodology based on comments received.
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