Ambulance Joint Response and Treat-and-Release Situations
Monday, November 19, 2018
Please note the following updates to TRICARE’s coverage of ambulance joint response and treat-and release situations.
Joint Response Reimbursement
In situations where a basic life support (BLS) ambulance provides the transport of a TRICARE beneficiary and an advanced life support (ALS) paramedic provides medically necessary services, the BLS ambulance supplier may bill TRICARE the ALS rate if an agreement between the BLS and ALS exists. A copy of the BLS/ALS agreement must be included with the claim.
Implemented Nov. 19, 2018, and retroactive to Sept. 13, 2018, TRICARE will cover joint response services from TRICARE-authorized providers without a BLS/ALS agreement, if the following circumstances exist:
- The ALS services are medically necessary.
- The ALS provider entity bills using either one of these codes:
- S0207 – paramedic intercept, non-hospital-based ALS service (non-voluntary), non-transport; or
- S0208 – paramedic intercept, hospital-based ALS service (non-voluntary), non-transport
For services prior to Sept. 13, 2018, if an agreement between the BLS and ALS does not exist, the beneficiary may be responsible for the expense of ALS services that were beyond the scope of the BLS payment.
Treat-and-release situations occur when an ambulance responds to a call and provides medical services, but the ambulance doesn’t transport the patient. Also implemented Nov. 19, 2018, and retroactive to Sept. 13, 2018, TRICARE covers treat-and-release services from TRICARE-authorized providers, under the following conditions:
- The services are medically necessary.
- Failure to provide a hospital transport was because transport was no longer required or the patient refused transport after receiving services.
- The ambulance provider bills using code A0998. The reimbursement rate will match Medicare’s rate for code A0428 (BLS non-emergency).
Treat-and-release ambulance services rendered prior to Sept. 13, 2018 are not covered under TRICARE, and the beneficiary could be responsible for the full amount of the claim.
The ALS entity and/or the ambulance company can submit claims for joint response and treat-and-release services. Please refer to the TRICARE Reimbursement Manual, Chapter 1, Section 14, for the most current codes, as codes may change over time. View our Ambulance Services Benefits A–Z page for additional benefit details.