Mercy Care RBHA would like to provide some guidance on billing for alternative non-emergency transportation, including bus passes and case manager travel when provided to members who do not have access to their own transportation.
Mercy Care RBHA has established some guidelines to ensure that all providers are billing for bus passes in a consistent manner. This is in line with Valley Metro bus pass charges.
Bus pass billing should only be billed at
per claim regardless of the number of bus passes given to the member. The billed charges will provide the information we need to track the number of bus passes given to the member.
The bus passes should be billed utilizing the following code and billed charges:
Non-emergency transportation and bus, intra- interstate carrier (may be used to encounter and/or bill for bus passes)
One 1-Day Pass A0110 1 $ 4.00
Two 1-Day Pass A0110 1 $ 8.00
Three 1-Day Pass A0110 1 $12.00
Four 1-Day Pass A0110 1 $16.00
Five 1-Day Pass A0110 1 $20.00
Six 1-Day Pass A0110 1 $24.00
One 7-Day Pass A0110 1 $20.00
One 15-Day Pass A0110 1 $33.00
One 31-Day Pass A0110 1 $64.00
Mercy Care RBHA would not expect a provider to bill for providing the member 5 or 6 1-Day passes if providing the member a 7-Day pass as the cost for a 7-Day pass is equal to or less than individual passes beyond 4 days.
Mercy Care RBHA will monitor bus pass billing to ensure that the units and billed charges are appropriate.
Case Manager Travel and Loaded Transportation
Mercy Care RBHA would like to provide clarification on case manager travel and loaded transportation.
For Non-Emergency Transportation (NEMT), there are two different billing scenarios:
- Loaded transportation is where the member is with staff.
- Provider travel is where the provider is traveling to where the member is to provide a service.
The AHCCCS Fee For Service (FFS) Manual, Chapter 14 states the following regarding loaded mileage:
Non-emergency transportation providers must bill the number of trips and the number of loaded miles as units of service on the CMS 1500 claim form. Loaded mileage is defined as the distance traveled, measured in statute
miles, with a recipient on board the vehicle and being transported to receive medically necessary AHCCCS covered services.
For all providers, please note that
services should be billed with both the appropriate base rate (A0100 or A0120) and the associated mileage (S0215). These codes are billed when transporting the member and are to be used by all staff levels including case managers. Claims/encounters should not be submitted without both codes for loaded transportation services. Mileage and base rate does not begin until the member is in the vehicle with the driver. The transportation to pick-up the member is not billable in terms of mileage or time.
, the member is not in the vehicle with the staff. The staff is traveling to where the member is to provide a service. This is billed utilizing code A0160 only. Please note, per the AHCCCS Covered Behavioral Health Services Guide that this code is not billable for the first 25 miles. The first 25 miles are unencountered. The only mileage that can be billed is mileage over the 25 mile threshold. This is true for each segment of the trip. This code is not billable to for travel time/mileage when going to pick up the member for loaded transportation.
Please note that for SMI and GMH/SU members who are in need of non-emergency transportation, this needs to be scheduled by a staff member of the clinical team and/or treatment agency and cannot be schedule directly by the member with a transportation vendor.
As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our
Mercy Care website
Thanks for all you do!