Cal. Code Regs. tit. 22, § 51527
(a) General Provision.
(b) Maximum reimbursement rates for medical transportation services shall be as follows:
Procedure Code
Maximum Allowance
(1) Ambulance Transportation
X0030
Ambulance service, basic life support (BLS) base rate, emergency transport, one way (includes allowance for emergency run)
$118.20
X0032
Non-emergency transportation, ambulance, base rate one way
107.16
X0002
Response to call, 2 patients, each patient (does not include an allowance for emergency run)
37.02
X0034
Ambulance service, (BLS) per mile, transport one way
3.55
X0004
Night call--7:00 p.m. to 7:00 a.m.
9.88
X0006
Emergency run
9.88
X0036
Ambulance service, oxygen, administration and supplies, life sustaining situation
9.88
X0008
Neonatal intensive care incubator
51.49
X0010
Waiting time over 15 min.--each 15 min
9.88
X0012
Compressed air for infant respirator
10.23
Extra attendant--RN, EMT, or equivalent; (in addition to normal crew of two):
X0014
First hour
16.44
X0016
Second and third hour, each hour
11.51
X0018
Each additional hour
5.25
X0020
Cost of IV fluids (invoice must be attached)
By Report
X0022
ECG in ambulance
16.07
A0999
Unlisted
By Report
(2) Air Ambulance Transportation
A0430
Ambulance service, conventional air services, transport, one way (fixed wing)
$ 1,275.00
A0431
Ambulance service, conventional air services, transport, one way (rotary wing)
1,800.00
X0500
Patient on board miles, helicopter, per mile
22.10
X0502
Patient on board miles, fixed-wing, per mile
14.25
X0504
Night call, 7:00 p.m. to 7:00 a.m
100.00
X0506
Waiting time over 15 minutes, each 15 minutes
25.00
X0508
Federal excise tax for fixed-wing aircraft over 6,000 pounds
10% of loaded mileage charge
X0510
Oxygen--per tank
9.88
X0512
Neonatal intensive care incubator
51.49
X0514
Compressed air for infant respirator
10.23
X0516
Administration of IV solution, 1000cc, including tubing and other supplies
13.00
X0518
Administration of IV solution, 500cc, including tubing and other supplies
7.00
X0522
Unlisted air transportation
By Report
(3) Wheelchair Van and Litter Van Transportation
X0200
Response to call, nonlitter patient: 1 patient
$17.65
X0202
2 patients, each patient
14.10
X0204
3 patients, each patient
11.71
X0206
4, or more patients, each patient
10.01
X0208
Wheelchair use
0.89
X0210
Response to call, litter patient in litter van
26.29
X0212
Attendant
5.52
X0214
Waiting time over 15 min.--each 15 min
5.65
X0216
Mileage one way--per mile
1.30
X0218
Night call--7:00 p.m. to 7:00 a.m.
6.13
X0220
Oxygen--per tank
11.86
X0222
Unlisted
By Report
(4) Patient transfer from discharging acute care hospital to a receiving skilled nursing facility or intermediate care facility.
X0400
Response to call, ambulance
$107.16
X0402
Ambulance mileage, one way--per mile
3.55
X0404
Response to call, litter patient in litter van
26.29
X0406
Response to call, non-litter patient
17.65
X0408
Litter van and wheelchair van mileage, one way--per mile
1.30
X0410
Wheelchair use
0.89
X0412
Oxygen--per tank
11.86
X0414
Attendant
5.52
X0416
Unlisted
By Report
Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14105 and 14136.5, Welfare and Institutions Code; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; Statutes of 1985, Chapter 111, Items 4260-106-001 and 890; Statutes of 1998, Chapter 324, Items 4260-101-0001 and 0890; Statutes of 1999, Chapter 50, Items 4260-101-0001 and 0890; and Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.
1. New subsection (b)(3) filed 4-11-84; effective thirtieth day thereafter (Register 84, No. 15). For prior history, see Register 81, No. 52.
2. Amendment of subsection (b) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84.
3. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
4. Amendment of subsection (b) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
5. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
6. Editorial correction of printing error in subsection (b)(2) and History 4. (Register 91, No. 30).
7. Amendment of subsection (b)(1), new subsection (b)(2) and amendment and redesignation of subsections (b)(3)-(b)(4) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
8. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
9. Amendment of subsection (b)(1) filed 8-2-95 as an emergency; operative 8-2-95 (Register 95, No. 31). A Certificate of Compliance must be transmitted to OAL by 11-30-95 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 8-2-95 order transmitted to OAL 11-22-95 and filed 1-3-96 (Register 96, No. 1).
11. Amendment of subsections (b)(1) and (b)(4) amendment of Note filed 3-1-99 as an emergency; operative 3-1-99 (Register 99, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-29-99 or emergency language will be repealed by operation of law on the following day.
12. Reinstatement of section as it existed prior to 3-1-99 emergency amendment by operation of Government Code section 11346.1(f) (Register 99, No. 33).
13. Amendment of subsections (b)(1) and (b)(4) and amendment of Note filed 8-10-99 as an emergency; operative 8-10-99 (Register 99, No. 33). A Certificate of Compliance must be transmitted to OAL by 12-8-99 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 8-10-99 order transmitted to OAL 12-2-99 and filed 1-13-2000 (Register 2000, No. 2).
15. Amendment of subsections (b)(1) and (b)(4) and amendment of Note filed 11-13-2000 as an emergency; operative 11-13-2000 (Register 2000, No. 46). A Certificate of Compliance must be transmitted to OAL by 3-13-2001 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 11-13-2000 order transmitted to OAL 3-13-2001 and filed 4-4-2001 (Register 2001, No. 14).
17. Amendment of subsection (b)(2) filed 12-19-2001 as an emergency; operative 12-19-2001 (Register 2001, No. 51). A Certificate of Compliance must be transmitted to OAL by 4-18-2002 or emergency language will be repealed by operation of law on the following day.
18. Certificate of Compliance as to 12-19-2001 order transmitted to OAL 4-9-2002 and filed 4-30-2002 (Register 2002, No. 18).
19. Amendment of subsections (b)(3)-(4), new subsection (c) and amendment of Note filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52, Items 4260-101-0001 and 0890 (Register 2002, No. 29).
20. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (c), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).