Medi-Cal GEMT

(Ground Emergency Medical Transportation (GEMT) Services Cost Report for the state of California - Department of Health Services)

GEMT providers are required to periodically submit data reports that include the following information:

  • ​The total number of emergency medical transports, as defined in statute, by payer type, including Medi-Cal FFS and Medi-Cal Managed care, Medicare, dual Medicare/Medi-Cal (Medi-Medi), and all other payer types, for each calendar year quarter. ​

    • Quarter 1-January, February, March

    • Quarter 2-April, May, June

    • Quarter 3-July, August, September

    • Quarter 4-October, November, December

  • The total gross receipts for any emergency medical transport that is billed with CPT code A0225 Neonatal Emergency, A0427 ALS Emergency, A0429 BLS Emergency, A0433 ALS2 and A0434 Specialty Care Transport.

    • "Gross receipts" are the combined gross payments received as patient care revenue for emergency medical transports paid by any payer type. Gross receipts shall not include supplemental amount received pursuant to Welfare and Institutions Code Section 14105.94.

Submission form definitions

The following shows the provider data submission form definitions per the California Department of Health Care Services:

  • Date of Service: The quarter of the CALENDAR YEAR the transports occurred

  • Provider Name: The name of the billing provider

  • NPI: The National Provider Identifier number of the billing provider

  • CPT Code: Current Procedural Terminology billing code

  • Medi-Cal FFS EM Gross Receipts: Total gross payments received as patient care revenue for Medi-Cal emergency medical transports paid by payment type Fee For Service

  • Medi-Cal MC EM Gross Receipts: Total gross payments received as patient care revenue for Medi-Cal emergency medical transports paid by payment type Managed Care

  • Medicare EM Gross Receipts: Total gross payments received as patient care revenue for emergency medical transports paid by payment type Medicare

  • Medi-Medi EM Gross Receipts: Total gross payments received as patient care revenue for emergency medical transports paid by both Medicare and Medi-Cal claim types

  • Other EM Gross Receipts: Total gross payments received as patient care revenue for emergency medical transports that were paid by any payment type other than Fee-for-Service, Managed Care, or Medicare

  • Optional Notes: May include descriptions of any adjustments and/or additional clarifications

Medi-Cal GEMT (ZB SSRS) payment report logic

Procedure codes: Reports only applicable procedure codes

  • A0225 (neonatal transport, emergency)

  • A0427 (ALS, emergency)

  • A0429 (BLS, emergency)

  • A0433 (ALS 2, emergency)

  • A0434 (Specialty Care Transport, emergency)*

Note: HCPCS code A0434 AND billed as emergency must both be present

Medi-Cal FFS: Medicaid (Medi-Cal) as Primary, no secondary. Depending on the account set up, the patient may be secondary.

  • We avoid “medical” in the name when the payer is not Medi-Cal

  • Medi_Cal_FFS_EM_Payments

    [PrimaryPayerIsMediCal] = Y

Medi-Cal Managed Care EM: Medicaid Managed Care as Primary, no secondary. Depending on the account set up, the patient may be secondary.

  • We avoid “medical” in the name when the payer is not Medi-Cal

  • Edge case: If a payer is a Medicaid Managed Care Plan but is set up as the payer type Medicaid in a customer’s system, that will appear in Medi-Cal FFS.

  • Medi_Cal_MC_EM_Payments

    [PrimaryPayerIsMediCal] =N AND [PrimaryPayerTypeIsMedicaid] =Y AND [PaymentPayerTypeIsMedicaid] = Y OR [PaymentPayerIsMediCal] = Y

Medicare EM: If the primary payer type is Medicare/Medicare Replacement and there is a secondary payment that is not Medicaid (because that would fall under Medi/Medi):

  • If Commercial is secondary, primary payment would fall under Medicare EM Payments. Secondary payment would fall under Other EM. (ie: Payment of $300 from Medicare and payment of $200 from Commercial, Medicare EM payments would be $300 and other EM would be $200).

  • Any secondary payments that are not Medicare/Medicare Replacement or Medicaid/Medicaid Replacement follow this logic.

  • Medicare_EM_Payments

    [PrimaryPayerTypeIsMedicare] = Y AND [SecondaryPayerTypeIsMedicaid] = N AND [SecondaryPayerPlanNameIsMediCal] = N

Medi/Medi: If the primary payer type is Medicare/Medicare Replacement and the Secondary is Medicaid, both payments would total under Medi Medi EM Payments. (ie: Payment of $300 from Medicare and payment of $200 from Medicaid, Medi/Medi EM payments would be $500).

  • Medi_Medi_EM_Payments

    [PrimaryPayerTypeIsMedicare] = Y AND [SecondaryPayerTypeIsMedicaid] = Y OR [SecondaryPayerPlanNameIsMediCal] = Y

Other EM Payments: Any payment type other than Medicaid FFS, Medicaid Managed Care, or Medicare/Medicare Replacement.

  • Other_EM_Payments

    WHEN [PrimaryPayerIsMediCal] = N AND [PrimaryPayerTypeIsMedicaid] = N AND [PrimaryPayerTypeIsMedicare] = N

Transport Totals:

  • Count of all transports that occurred within the quarter, based on Date of Service

    • This is different logic than the Gross Receipt Totals

    • Details are split to show both Transport Details and Payment Details (previously this total was a summary)

    • This will create a fourth page, on the report or a fourth tab in Excel, to be created in the following order:

      • Payments-Summary

      • Transports-Summary

      • Payments-Detail

      • Transports-Detail

Gross Receipt Totals:

  • Calculates all revenue received for transports that were paid within the quarter, based on Deposit Date

  • Secondary payments are included