Reminder: Billing Transportation Services That Include Day and Night Hours
This is a reminder to providers when billing transportation services for a round trip that encompasses day and night hours to reflect one unit for each leg of the trip. Manual section, Medi-Cal Transportation – Ground defines night calls as “transportation responses between the hours of 7 p.m. and 7 a.m.”
Proper Billing Example:
Round-trip transportation that includes one night call (modifier UJ) |
From | Through | Service Code | Modifier | Rate | Units |
8/14/18 | 8/14/18 | A0130 | $ 17.65 | 001 | |
8/14/18 | 8/14/18 | A0130 | UJ | $ 23.78 | 001 |
The above billing example will decrement the remaining occurrences approved on the Treatment Authorization Request (TAR) by two units.
Improper Billing Example:
Round-trip transportation that includes one night call (modifier UJ) |
From | Through | Service Code | Modifier | Rate | Units |
8/14/18 | 8/14/18 | A0130 | $ 35.30 | 002 | |
8/14/18 | 8/14/18 | A0130 | UJ | $ 6.13 | 001 |
The above improper billing example will decrement the remaining occurrences approved on the TAR by three units rather than two units. Billing improper units causes claims to deny with Remittance Advice Details (RAD) code 079: Service billed exceeds remaining occurrences approved on the TAR (Treatment Authorization Request).
All transportation services must document the start and stop times for each leg of the services.
Refer to Medical Transportation – Air: Billing Codes and Reimbursement Rates and Medical Transportation – Ground: Billing Codes and Reimbursement Rates in the Part 2 manual for specific codes, maximum reimbursement amounts and further instructions.