Loaded miles in fee-for-service Medi-Cal
The Medi-Cal provider manual has wheelchair van and litter van mileage billed with HCPCS A0380, and ambulance mileage with A0425. The units are the total miles from the recipient’s pickup to the destination (and the return miles for a round trip billed on one line), and the claim must show the full pickup and destination addresses, with city and ZIP code.
How payers measure them
Payers don’t all count miles the same way. Some pay the routed distance between the two addresses, some the GPS trail the van actually drove, some the odometer readings at pickup and drop-off, and some the miles in their own trip file. They also differ on rounding and on caps per leg. The same leg can be 7.4 miles to one payer and 8 to another.
What it means for the provider
Record the miles every way a payer might ask for them, then bill each payer its own way. The miles with nobody on board are deadhead miles, and they are usually not paid.
Related terms
- Deadhead miles (empty miles)Deadhead miles, or empty miles, are the miles a vehicle drives with no rider on board: from the yard to the first pickup, between a drop-off and the next pickup, and back to the yard at the end of the day.
- Medi-Cal NEMT billing codes (HCPCS)HCPCS codes are the billing codes for each service on a claim.
- Trip leg (A leg and B leg)A trip leg is one one-way ride from a pickup to a drop-off.
- Payer (funding source)The payer, also called the funding source, is whoever pays for a trip leg: a broker, a health plan directly, Medi-Cal fee-for-service, a facility, a workers’ compensation administrator or the rider.
- Trip sheet and manifestA trip sheet is the record of what happened on each leg that a payer asks for before it pays: times, miles, driver, vehicle and signatures.
Sources
Checked on . Rules change: check the current version with the payer before you bill.