Air Ambulance Batching Policy

Question:

May disputes for air ambulance services for a single air ambulance transport that are initiated on or after August 3, 2023, be submitted as a batched dispute?

Answer:

Yes. Air Ambulance (liftoff, base rate, and mileage) codes can be batched together as long as they follow the assigned entities batching policy

Summary:

As a result of this guidance, Air Ambulance (liftoff, base rate, and mileage) codes can be batched together as long as they follow the assigned entities batching policy. For example, the aforementioned codes can be batched together with FHAS if the following are met:

1. The items and services are furnished by the same provider or facility;
2. Payment for the items and services are made by the same group health plan or health insurance issuer;
3. Items and services were furnished during the 30-day period following the date on which the first item or service included in the batched determination was furnished; and
4. Such items and services are related to the treatment of a similar condition

Background

“On August 24, 2023, the District Court issued an opinion and order in Texas Medical Association, et al. v. U.S. Department of Health and Human Services, et al., Case No. 6:22-cv450-JDK (TMA III). As relevant to this document, this order vacated portions of the August 2022 Technical Guidance for Certified Independent Dispute Resolution (IDR) Entities (August 2022 Technical Guidance)2 that provided that the two service codes (one representing a liftoff code, or base rate, and the other representing a mileage code) for a single air ambulance transport could not be considered together in a single IDR dispute. As a result of the TMA III decision, effective August 24, 2023, the Departments temporarily suspended all Federal IDR process operations in order to make changes necessary to comply with the District Court’s opinion and order” – IDR Batching and Air Ambulance FAQs (cms.gov).

​As a result of the TMA III order, air ambulance services for a single air ambulance transport, including an air ambulance mileage code and base rate code, may be submitted as a batched dispute, so long as all provisions of the batching regulations are satisfied, in accordance with Q2 of these FAQs. Nothing in this guidance or the TMA III opinion and order precludes an air ambulance mileage code or base rate code from being submitted separately as a single dispute” – FAQs about Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 63 (cms.gov).