CurrentMississippi Division of MedicaidPolicy N/A

Emergency ambulance and air ambulance transportation services coverage criteria

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Rules governing Medicaid coverage, provider requirements, definitions, and covered emergency ground and air ambulance services for Mississippi Division of Medicaid. Applies to ambulance service providers whose origin or pickup site is within Mississippi and to services meeting BEMS requirements.

Policy Summary

PayerMississippi Division of Medicaid

PolicyEmergency ambulance and air ambulance transportation services coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 1, 2024

Last ReviewFeb 1, 2024

Next Review DateN/A

Key ActionMaintain proof of BEMS permit/license, NPI verification, IRS tax identification confirmation, required staffing/equipment documentation, and records supporting mileage and injectable drug usage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Part 201 Ch.1Location in administrative code

02/01/2024Most recent revision

BLS, ALS, AirTransport types covered

Mileage & drugs

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CurrentMississippi Division of MedicaidPolicy N/A

Emergency ambulance and air ambulance transportation services coverage criteria

Customize your policy alerts

Sign up for all Mississippi Division of Medicaid policy alerts

Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

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Policy Summary

PayerMississippi Division of Medicaid

PolicyEmergency ambulance and air ambulance transportation services coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 1, 2024

Last ReviewFeb 1, 2024

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Part 201 Ch.1Location in administrative code

02/01/2024Most recent revision

BLS, ALS, AirTransport types covered

Mileage & drugs

Additional billables

Coverage Criteria — Emergency Ambulance & Air Ambulance

Medically necessary emergency ambulance and air ambulance services

Covered when ALL of the following are met

Provider and licensure requirements: Provider must have applicable MSDH/BEMS license or permit (if origin/pickup is within Mississippi), meet Part 200/Part 201 requirements, provide a National Provider Identifier (NPI) with NPPES verification, submit written IRS confirmation of tax identification number and legal business name, perform required criminal background checks, and ensure all personnel are certified/licensed acting within their scope of practice.

Out-of-state providers must comply with licensing/permit requirements of the state where services are provided and meet all other Part 201 requirements.

Service-level BEMS requirements: The ambulance or air service and the transport must meet BEMS permit, staffing, equipment, and mission requirements appropriate to the level of service: BLS, ALS, rotary‑wing air, fixed‑wing air, or neonatal transport. Examples include: BLS vehicle with BEMS permit staffed by at least one BEMS‑certified EMT and a driver with a valid Mississippi EMS Driver Certificate; ALS vehicle with BEMS permit staffed by at least one AEMT or higher; air ambulance with BEMS permit, properly credentialed pilot, and air medical personnel (paramedic, RN, physician) as required by BEMS.

Transportation must be to the nearest appropriate facility.

Medical necessity: The beneficiary has an emergency medical condition and the severity of the condition makes other methods of transportation contraindicated; the ambulance transport and the level of service provided are required.

Emergency medical condition defined by sudden onset of symptoms that a prudent layperson would reasonably expect could result in serious jeopardy, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part.

The Division prohibits emergency ambulance service providers from selling subscriptions, memberships, or similar payment packages that cover Medicaid beneficiary copayments. Providers must still meet all other licensure and documentation requirements specified for providers whose origin or pickup site is in Mississippi, including MSDH/BEMS licenses or permits, NPI verification, IRS confirmation of tax identification and legal business name, and required criminal background checks.

Transportation will not be covered when it does not meet the policy definition of medical necessity for emergency ambulance transportation. Medical necessity requires that (1) the severity of the beneficiary’s emergency medical condition makes other methods of transportation contraindicated and (2) both the ambulance transport itself and the level of service provided are required. Situations that fail either condition (for example, where non-emergency transport is appropriate or the ambulance level of service is not required) are not covered.

Provider Requirements, Authorization & Documentation

Prior Authorization

Prior authorization — not required; coverage contingent on medical necessity

No prior authorization is required for emergency ambulance or air ambulance transports; coverage is conditioned on medical necessity and meeting the BEMS and provider requirements specified by the Division of Medicaid.

Step Therapy

Step therapy — none for emergency transport

There are no step therapy requirements for emergency transportation services under this rule set.

Documentation Required

Required provider documentation

Key Definitions

Medical Necessity (emergency ambulance transportation)

DefinitionThe severity of the beneficiary's emergency medical condition is such that the use of any other method of transportation is contraindicated, and the beneficiary's emergency medical condition requires both the emergency ambulance transportation itself and the level of service provided.

Required element - severityCondition severity must make other transport methods contraindicated.

Required element - service necessityBoth the ambulance transport and the level of service provided must be required for the beneficiary's condition.

Documentation implicationProviders must document clinical findings showing contraindication of other transport methods and necessity of the level of service rendered.

Emergency Medical Condition

Layperson definition

Background & Scope

Medical necessity for emergency ambulance transport is determined by the beneficiary’s clinical presentation and the risk posed by delaying care. Under this policy, medical necessity is present when the beneficiary’s emergency medical condition is of sufficient severity that other modes of transport are contraindicated and the ambulance transport and level of service provided are required. An emergency medical condition is defined as a sudden onset of acute symptoms (including severe pain) such that a prudent layperson could reasonably expect that lack of immediate medical attention would result in serious jeopardy to health, serious impairment of bodily functions, or serious dysfunction of any organ or part. Providers must also meet all applicable BEMS/provider requirements for licensing, staffing, equipment, and documentation for the transport to be covered.

Revision History

2024-02-01RevisionLatest

Rule history updated to reflect multiple revisions with effective date Revised eff. 02/01/2024 (applies to Part 201 Chapter 1 Emergency Transportation Services).

2023-05-01Revision

Rule 1.3 revised to correspond with State Plan Amendment (SPA) 23-0004 effective 02/01/2023 with implementing revision eff. 05/01/2023.

2018-08-01Revision

Policy Summary

PayerMississippi Division of Medicaid

PolicyEmergency ambulance and air ambulance transportation services coverage criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 1, 2024

Last ReviewFeb 1, 2024

Next Review DateN/A

SourceLink

On This Page

Providers must retain and be able to produce documentation proving licensure, identity, and compliance with BEMS and Medicaid administrative requirements.

Proof of applicable MSDH/BEMS license or permit (for services with origin/pickup in Mississippi) or evidence of compliance with the licensing/permit requirements of the state where services are provided (Rule 1.1.A–B).
National Provider Identifier (NPI) with NPPES verification (Rule 1.1.A.3).
Written IRS confirmation of the provider's tax identification number and legal business name (Rule 1.1.A.4).
Documentation of required staffing and credentials (e.g., BLS/ALS certified personnel, EMS driver certificates, air medical personnel) and vehicle BEMS permits (Rule 1.3.A–C).
Evidence of criminal background checks as required by law and policies showing prohibited employees are not employed (Rule 1.1.C).
Records supporting billed loaded mileage and discarded injectable drug amounts recorded in the beneficiary's medical record with provider policies for single‑use drugs (Rule 1.3.E and 1.3.4).

Denial Risk

Credential/documentation risks — missing or noncompliant credentials may cause denial

Failure to possess or produce required credentials, registrations, or mandated background checks may result in nonpayment or denial of claims.

Absence of an applicable MSDH/BEMS license or permit when the origin/pickup is in Mississippi.
No valid NPI/NPPES verification or missing IRS confirmation of TIN and legal business name.
Lack of required criminal background checks or employment of persons convicted of disqualifying crimes.
Insufficient documentation of personnel certification/licensure, EMS driver certificate, or required BEMS permits for vehicles and aircraft.

Sudden onset of acute symptoms of sufficient severity (including severe pain) that a prudent layperson with average health knowledge could reasonably expect lack of immediate medical attention to result in serious jeopardy to health, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part.

Key consequence 1Serious jeopardy to the health of the beneficiary.

Key consequence 2Serious impairment to bodily functions.

Key consequence 3Serious dysfunction of any bodily organ or part.

Basic Life Support (BLS)

DefinitionBasic Life Support (BLS) services are non-invasive emergency procedures and services at the EMT NSTC level, including but not limited to airway maneuvers, CPR, automated/semi-automated defibrillation, hemorrhage control, spinal immobilization, assistance with childbirth, and obtaining vital signs.

Included example - airway/CPR/defibrillationInitiation of basic airway maneuvers and procedures; cardio-pulmonary resuscitation (CPR); automated and semi-automated defibrillation.

Included example - hemorrhage/immobilization/childbirthHemorrhage control (direct pressure, tourniquet), spinal immobilization and extremity stabilization, and assistance with childbirth.

Authority noteAlso includes other techniques as authorized by the Bureau of Emergency Medical Services (BEMS).

Advanced Life Support (ALS)

DefinitionAdvanced Life Support (ALS) services are a sophisticated level of prehospital and interhospital emergency care including cardiac monitoring/defibrillation, telemetered ECG, antiarrhythmic administration, IV therapy, specified medications, adjunctive ventilation, and trauma care.

Included example - cardiac careCardiac monitoring, cardiac defibrillation, and telemetered electrocardiography.

Included example - medications/IV/ventilationAdministration of antiarrhythmic agents; intravenous therapy; administration of specified medications, drugs, and solutions; use of adjunctive ventilation devices.

Included example - trauma careTrauma care and other techniques and procedures authorized by BEMS.

Prior revision recorded with effective date Revised eff. 08/01/2018 (appears in Rule history for Part 201 Chapter 1).