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COASTAL HEALTH SYSTEMS OF BREVARD, INC. <br />TRANSPORT RATE SCHEDULE <br />AMBULANCE TRANSPORTATION <br />BLS Non -Emergency <br />$290.00 <br />ALS Non -Emergency <br />$400.00 <br />BLS Emergency <br />$440.00 <br />ALS Emergency <br />$520.00 <br />ALS -2 <br />$775.00 <br />ALS -SCT $890.00 <br />All Mileage. $11.25 per mile <br />Stand -By or Waiting Time $125.00 per hour <br />or increment thereof <br />In addition to Coastal's primarily non -emergency inter facility services, Coastal routinely renders <br />ambulance services in response to facility requests that fall into the Center for Medicare and <br />Medicaid Services (CAIS) guidelines qualifying Coastal for reimbursement under the CMS code <br />for ALS or BLS Emergency based on the "immediate response" criteria. The current CMS <br />definition for Emergency is not based on "lights and sirens", it is based on "immediate response". <br />Under this contract, Coastal will bill the ALS or BLS Emergency rates only when an immediate <br />response is rendered following an inter facility or 911 request and only when all other CMS <br />criteria for this type of transport have been met. <br />SERVICE CHARGES for ADDITIONAL PERSONEL/SPECIAL EOUIPMENT <br />Stair Chair - Hydraulic Stretcher Use — Lift Assist <br />$100 Additional Charge for each service i crew / equipment. <br />*There is a one-hour minimum charge for all wait time. <br />Note: The above rates are subject to change based on changes made by Medicare or by <br />Coastal's Ambulance Franchise Contract with Brevard County and will be automatically <br />updated in Coastal's billing database on the effective date of. each change. <br />173 <br />