Ambulance Services are nonemergency and emergency patient transports that are reimbursed by Texas Medicaid. These services include out-of-hospital acute medical care, transport to definitive care, and other medical transport to patients with illnesses and injuries which prevent the patients from transporting themselves. To enroll in the Texas Medicaid Program, ambulance providers must operate according to the laws, regulations, and guidelines governing ambulance services. More information about these services may be found in the Ambulance Services Handbook portion of the Texas Medicaid Provider Procedure Manual located on the Texas Medicaid and Healthcare Partnership (TMHP) website.
Payment Rate Information
Payment rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid & Healthcare Partnership (TMHP) website (see Fee Schedules)
Methodology / Rules
The Ambulance Services program rules are located at Title 1 of the Texas Administrative Code (TAC), Part 15, Chapter 354, SubChapter A, Division 9, Rule 1111, 1113, and 1115.
Reimbursement rules applicable to Ambulance Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 31, Rule 8600.
The fee schedules and any periodic adjustment(s) to the fee schedules are published in banner messages contained in provider Remittance and Status (R&S) reports, Medicaid Bulletin articles, web postings, provider manual, fee schedules or other provider notification.
The Center of Medicare and Medicaid Services (CMS) requested that HHSC make modifications to the Ambulance UC protocol to restrict the ability of providers to claim costs in excess of those for direct medical care associated with uninsured charity care. The changes in the protocol and cost report tool will specify that UC Ambulance providers report uninsured charity care costs directly attributed to direct medical services. These changes will be submitted to CMS on January 6, 2023.
View the Direct Medical Care Cost Report (.xslx)
Tx-healthcare-transfromation-Attachment H 2022 (.pdf)
Ambulance Services Supplemental Payment Program (ASSPP)
Governmental ambulance providers may receive a supplemental payment if the governmental ambulance provider's allowable costs exceed the fee-for-service revenues received during the same period. An approved ambulance provider that meets the required enrollment criteria may receive supplemental payments up to reconciled costs with the submission of an annual cost report. Cost reports will be based on a cost to billed charge ratio methodology.
Eligibility for Ambulance Services Supplemental Payment Program
A governmental ambulance provider must submit their request to become eligible for a supplemental payment to the HHSC Uncompensated Care Tools mailbox at PFD_Hospitals@hhsc.state.tx.us. The request, if acceptable, will be effective the first day of the month after the request is approved.
View the Application Request Criteria (.pdf)
View the Cost Report Training information
Uncompensated Care (UC) Payment Schedules
The finalized Uncompensated Care (UC) Payment files displays the final payments which include payment reductions made to remain within the aggregate limit (maximum funding) for each demonstration year (DY) within the waiver period.
View the FFY 2021 (DY10) UC Payment (.pdf) information
View the FFY 2020 (DY9) UC Payment (.pdf) information
View the FFY 2019 (DY8) UC Payment (.pdf) information
View the FFY 2018 (DY7) UC Payment (.pdf) information
View the FFY 2017 (DY6) UC Payment (.pdf) information
View the FFY 2016 (DY5) UC Payment (.pdf) information
View the FFY 2015 (DY4) UC Payment (.pdf) information
View the FFY 2014 (DY3) UC Payment (.pdf) information
View the FFY 2013 (DY2) UC Payment (.pdf) information
View the FFY 2012 (DY1) UC Payment (.pdf) information