States Applicable to Alert: Northern and Southern California
Background Information: HCPCS Code A0434 – Specialty Care Transport - had been denied when submitted by providers who were not designated an ALS provider in our system. It has been determined that this service may be provided by a BLS ambulance service that does meet the qualifications of having the qualified, trained personnel/supplies and proper equipment on board and medical necessity is met.
Palmetto GBA has been denying these services since September 2, 2008; therefore, an adjustment will be performed on denied services.
Applicable CPT Codes: A0434 – Specialty Care Transport
Modifier(s): N/A
Remark /Reason Codes:
B7 - This provider was not certified/eligible to be paid for this procedure/service on this date of service.
MAC Action: Palmetto GBA will be identifying claims that were processed since September 2, 2008 and denied. A mass adjustment will be performed in the near future and payments will be issued.
A mass adjustment was completed July 14, 2009. A total of 1,334 claims for Northern and Southern California were found.
Provider Action: No action is required.
Date Reported: June 23, 2009
Date Resolved: July 14, 2009