Jan 1, 2019 • Guideline Updates / Reimbursement Policies

In early 2018, Anthem Blue Cross and Blue Shield (Anthem) became one of the first major insurers to reimburse EMS providers for appropriate and medically necessary care billed under HCPCS code A0998 (Ambulance response and treatment, no transport). The code, which has been active since January 2018 for most standard Anthem benefit plans, allows EMS providers to receive reimbursement for treatment rendered in response to an emergency call to a member’s home or scene, when transportation to the hospital emergency room (ER) was not provided. Previously, Anthem reimbursed EMS providers for treatment rendered only when a patient was transported to the ER.

 

Important reminders:

  • The code is currently active and available for EMS use.
  • If an EMS provider responds to an emergency call and provides appropriate treatment at-home or on-site without transporting to the ER, code A0998 can be used.
  • The EMS provider must render treatment to the patient per EMS protocols which are approved by the medical director at the local or state level.
  • Billing of A0998 when treatment is not rendered is not appropriate.
  • Anthem will apply medical necessity review to A0998 using clinical guideline CG-ANC-06.
  • HCPCS code A0998 applies to all of Anthem’s commercial health plans, and reimbursement will be made in accordance with the member’s benefits.

 

Questions?

  • For contract questions, please reach out to your contract representative.
  • For questions about using code A0998, please reach out to Jay Moore, Senior Clinical Director for Anthem, Inc.

 


Featured In:
January 2019 Anthem Indiana Provider Newsletter