Ambulance Treatment-in-Place Billing Guidelines and Telehealth Billing Guidelines Effective March 2020
Date: 04/28/21
Louisiana Healthcare Connections would like to remind providers about changes made by the Louisiana Department of Health regarding Ambulance Treatment-in-place and telehealth billing guidelines, effective for dates of service on or after March 1, 2020.
Treatment-in-Place Claim:
The treatment-in-place ambulance service must be separately billed from the treatment-in-place telehealth service. The ambulance provider’s NPI must be enrolled as an ambulance service billing provider. Treatment-in-place is classified as an emergency transportation service and should be billed with a payable ambulance treatment-in-place code. Supply codes A0382 and A0398 are payable but mileage A0425 and other ambulance transportation services are not payable. Claims billed with non-payable ambulance treatment-in-place services will be denied.
Claims must indicate treatment-in-place destination code ‘W’ in the destination position of the origin/destination modifier combination.
| Modifier | Origination Site | Destination |
| DW | Diagnostic or therapeutic site other than P or H when these are used as origin codes | Tx-in-Place |
| EW | Residential, domiciliary, custodial facility (other than 1819 facility) | Tx-in-Place |
| GW | Hospital based ESRD facility | Tx-in-Place |
| HW | Hospital | Tx-in-Place |
| IW | Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport | Tx-in-Place |
| JW | Freestanding ESRD facility | Tx-in-Place |
| NW | Skilled nursing facility | Tx-in-Place |
| PW | Physician's office | Tx-in-Place |
| RW | Residence | Tx-in-Place |
| SW | Scene of accident or acute event | Tx-in-Place |
If a patient being treated in placed has a real-time deterioration in their clinical condition necessitating immediate transport to an emergency department, the ambulance provider cannot bill for both treatment in place ambulance service and the transport to the emergency room. In this case, the ambulance provider shall bill only the emergency department transport.
Requests for consideration or reconsideration of claim denials for multiple treatment in place and treatment in place and transport claims rendered on the same date of service for the same recipient, should be submitted to LHCC with Pre-Hospital Care Summary Reports demonstrating the services were rendered for different occurrences.
Reconsideration and Pre-Hospital Care Summary Report can be attached to the claim and submitted paper claim or via Provider Portal:
Paper Claim:
Louisiana Healthcare Connections
Attention: Claims
P.O. BOX 4040
Farmington, MO 63640-3826
Provider Portal:
For information purposes, ambulance providers may include G2022 on ambulance transportation claims to an ER that met ET3 model but the member refused TIP and transportation to alternative destination (TAD).
| Procedure Code | Description | When to use it | Where to use it | Fee |
| G2022 | Beneficiary refuses treatment in place services | Ambulance transport claims to an ER that met TIP and TAD but the patient refused | CPT/HCPCS Code Field | $0.00 |
Treatment-in-Place Telehealth Claims:
Treatment-in-place telehealth services must be separately billed from treatment-in-place ambulance services. The billing providers NPI must be enrolled as a professional service billing provider.
Claims for allowable telehealth procedure codes must be billed with the addition of G2021 procedure code. The G2021 code will be accepted, paid at $0.00 and used by Medicaid to identify treatment-in-place telehealth services. As with all telehealth claims, providers must include POS identifier of ‘02’ and modifier ‘95’ with their claim to identify the claim as a telehealth service. Providers must follow CPT guidance relative to the definition of a new patient versus an established patient.
| Procedure Code | Modifier | Place of Service | Description | When to use it | Where to Use it | Fee |
| G2021 | 95 | 02 | TIP telehealth service | When providing TIP telehealth services | CPT/HCPCS Code Field; Must be used when providers bill claims for the telehealth service. | $0.00 |
The rendering provider’s NPI must be reported on the claim for both the E&M telehealth procedure code and the G2021 procedure code. Valid rendering providers are licensed physicians, advanced practice registered nurses, and physician assistants. Rendering providers must be ‘linked’ to the billing provider.
| Category | Service | CPT Codes |
| Evaluation and Management, Office or Other Outpatient Service | New Patient | 992012, 99202,99203,99204,99205 |
| Established Patient | 99211, 99212, 99213, 99214,99215 |
Louisiana Medicaid Fee Schedule
Claims failing to adhere to these requirements are subject to post-payment review, recoupment, and additional sanctions as deemed appropriate by Louisiana Medicaid.