Beginning with dates of service on and after September 1, 2018, Anthem Blue Cross (Anthem) will reimburse appropriate and medically necessary care billed under HCPCS code A0998 (Ambulance response and treatment, no transport) by Emergency Medical Service (EMS) providers.

 

The HCPCS code is billed when care is provided in response to an emergency call to a member’s home or on a scene, whether or not transportation to the hospital was necessary and occurred. In the past, Anthem reimbursed EMS providers for treatment rendered only when the patient was transported to the hospital emergency room.  Anthem will apply medical necessity review to A0998 using coverage guideline CG-ANC-06.

 

Providers should only submit A0998 when:

  1. The member consents to evaluation and treatment, AND
  2. After evaluation, medic and patient agree there is not a medical emergency, AND
  3. The member does not desire transport to an emergency department for evaluation, AND
  4. The member is stable for referral to the patient’s physician or other community resource, AND
  5. The member has the ability (mental capacity, transportation resources) to obtain assistance and medically indicated follow-up

 

For more information, please contact your contract representative.



Featured In:
October 2018 Anthem Blue Cross Provider Newsletter - California