Section 0800-02-18-.13 - AMBULANCE SERVICES GUIDELINES(1) All non-emergency ground and air ambulance service provided to workers' compensation claimants shall be pre-certified. Emergency ground and air ambulance services may be retrospectively reviewed within three (3) business days.(2) All ground and air ambulance services shall be medically necessary and appropriate. Documentation and trip sheets shall be submitted with the bill that states the condition and that indicates the necessity of the ground and air ambulance service provided. It should readily indicate the need for transport via this mode rather than another less expensive form of transportation. The service billed shall be supported by the documentation submitted for review.(3) Billing shall be submitted to the employer or carrier on a properly completed CMS-1500 form (or its successor form) by HCPCS code. Hospital based or owned providers shall submit charges on a CMS-1500 form (or its successor form) by HCPCS code.(4) Reimbursement shall be based upon the lesser of the submitted charge or the amount listed in the rate tables. To the extent permitted by federal law, the rates determined in the preceding sentence shall also apply to air ambulance services.Tenn. Comp. R. & Regs. 0800-02-18-.13
Public necessity rule filed June 5, 2005; effective through November 27, 2005. Public necessity rule filed November 16, 2005; effective through April 30, 2006. Original rule filed February 3, 2006; effective April 19, 2006. Amendment filed March 12, 2012; to have been effective June 10, 2012. The Government Operations Committee filed a stay on May 7, 2012; new effective date August 9, 2012. Amendments filed November 27, 2017; effective February 25, 2018. Administrative changes made to this chapter on September 10, 2019; "Tennessee Workers' Compensation Act" or "Act" references were changed to "Tennessee Workers' Compensation Law" or "Law." Amendments filed June 27, 2023; effective 9/25/2023.Authority: T.C.A. §§ 50-6-204, 50-6-205, and 50-6-233 (Repl. 2005).