Welcome to the State of Nevada Division of Health Care Financing and Policy (DHCFP) Community Paramedicine Services webpage.
Community Paramedicine is a health care delivery model. Existing programs both nationally and internationally have demonstrated health care savings related to reduced emergency room usage, reduced hospital readmissions, reduced emergency transports, increased access to primary care services, and improvements in health outcomes especially chronic conditions. With Community Paramedicine, EMTs, Advanced EMTs, and paramedics provide basic and preventive health care services to individuals in their homes via a collaborative partnership with the patient’s primary care provider and the Community Paramedicine program. Community Paramedicine programs can also collaborate with other providers within the community to improve access to care and fill gaps that occur in our current health care system.
Through stakeholder engagement, DHCFP developed a policy and payment methodology that allows Nevada Medicaid providers to receive reimbursement for these valuable services. This policy went into effect July 1, 2016.
Each Community Paramedicine program may be designed differently as they are based upon the needs of the community. For example, the program could look very different in rural and urban settings. If you need any assistance or have questions on getting started in your design or how to enroll into Nevada Medicaid, please see the contacts on the right-hand side of this page
What is Community Paramedicine?
Per NRS 450B.0615, Community paramedicine services means services provided by an emergency medical technician, advanced emergency medical technician, or paramedic to patients who do not require emergency medical transportation and provided in a manner that is integrated with the health care and social services resources available in the community.
Who can provide Community Paramedicine services?
Nevada permitted Emergency Medical Services (EMS) agencies and Nevada licensed hospitals can perform Community Paramedicine services. However, an EMS agency must have the Community Paramedicine endorsement on their agency permit and a hospital must have a Community Paramedicine endorsement letter.
The provider actually performing the Community Paramedicine services includes an Emergency Medical Technician (EMT), Advanced EMT, or Paramedic that has also earned the Community Paramedicine endorsement on their certificate. These professionals must be employed or volunteer with the EMS agency or hospital described.
Who licenses and regulates Community Paramedicine?
Southern Nevada Health District, EMS and Trauma System (Clark County EMS Agencies Only)
Division of Public and Behavioral Health, EMS Office (rest of the state for EMS and hospitals)
Which health plans reimburse for Community Paramedicine?
Nevada Medicaid is the only public payor that reimburses for Community Paramedicine services. This includes Fee-for-Service and the Managed Care Organizations.
How to Enroll
Use the Fee-for-Service Provider Enrollment Checklists to enroll. Please use the checklist for PT 32, Specialty 249 for Community Paramedicine.
The Provider Enrollment Information Booklet is an additional helpful tool.
Managed Care Organizations contacts:
Anthem BlueCross BlueShield
Health Plan of Nevada
What Provider Type is Community Paramedicine?
Community paramedicine is now PT 32, Specialty 249.
National Provider Identifier (NPI)
An EMS agency and hospital will need a new separate NPI that will solely be used for Community Paramedicine claims. An individual EMT will also need their own NPI. If an individual EMT already has an NPI, that existing number can be used. Apply for an NPI here.
What is the Nevada Medicaid coverage policy for Community Paramedicine services?
The policy is found in the Medicaid Services Manual, Chapter 600, Section 604.
Recipient-Specific Plan of Care
Per Nevada Medicaid policy, a Community Paramedicine Program must collaborate with a primary care physician (MD, DO, APRN, PA) to coordinate a care plan for the Medicaid recipient. If the recipient already has a local primary care provider, the Community Paramedicine program must collaborate with that provider on a care plan. If the recipient does not have a primary care provider, it is best to develop a partnership with a local primary care provider who can partner with the Community Paramedicine program for these types of recipients.
How to Submit Claims
Please reference Billing Guide for PT 32, Specialty 249 for information on how to submit claims.
What if the recipient has both Medicare and Medicaid insurance?
Medicare does not cover Community Paramedicine. However, Nevada Medicaid does cover this service. Medicaid Services Manual (MSM), Chapter 100, Section 104.1 explains how to bill when Medicare is primary and Medicaid is secondary. Please also see Web Announcement # 1941 for further explanation on how to bill.
Fee-for-Service reimbursement rates are available on our website. Please contact the Managed Care Organizations for their reimbursement rates.
Providers who have questions regarding Community Paramedicine billing or would like to request one-on-one training may contact the Nevada Medicaid Field Service Representatives at NevadaProviderTraining@dxc.com.
All Nevada Medicaid Web Announcements are posted on our website. Below are some critical web announcements for your review.
Web Announcement # 2018 posted on 11/4/2019