| Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Non-Emergency Medical Transportation | | 05/03/2024 | Covered and Noncovered Services : Covered Services and RequirementsTopic #11898 Advanced Life Support and Basic Life Support Procedure Codes Covered by ForwardHealth and Not Reimbursed by the NEMT Manager
Providers should submit claims with the following BLS and ALS procedure codes to ForwardHealth, not to the NEMT manager contracted with the Wisconsin DHS.
| Procedure Code |
Description |
| A0225 |
Ambulance service, neonatal transport, base rate, emergency transport, one way |
| A0384 |
BLS specialized service disposable supplies; defibrillation (used by ALS ambulances and BLS ambulances in jurisdictions where defibrillation is permitted in BLS ambulances) |
| A0392 |
ALS specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in BLS ambulances) |
| A0394 |
ALS specialized service disposable supplies; IV drug therapy |
| A0396 |
ALS specialized service disposable supplies, esophageal intubation |
| A0422 |
Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation |
| A0424 |
Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review) |
| A0427 |
Ambulance service, advanced life support, emergency transport, Level 1 (ALS1-Emergency) |
| A0429 |
Ambulance service, basic life support, emergency transport (BLS-Emergency) |
| A0430 |
Ambulance service, conventional air services, transport, one way (fixed wing) |
| A0431 |
Ambulance service, conventional air services, transport, one way (rotary wing) |
| A0432 |
Paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company, which is prohibited by state law from billing third party payers |
| A0433 |
Advanced life support, Level 2 (ALS2) |
| A0434 |
Specialty care transport (SCT) |
| A0435 |
Fixed wing air mileage, per statute mile |
| A0436 |
Rotary wing air mileage, per statute mile |
| A0998 |
Ambulance response and treatment, no transport |
| A0999 |
Unlisted ambulance service |
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