People standing in front of an ambulance


The professional fee schedule format lists procedure codes, descriptions, and fee screens. The modifier and age range fields are applicable to the fee screen and do not reflect coverage parameters.  For additional pertinent coverage parameters, such as documentation and billing indicators, refer to the Medicaid Code and Rate Reference tool, which is accessible via the External Links menu within CHAMPS.  Medicaid Code and Rate Reference is an online code inquiry system that provides real-time information for the following:

  • Age restrictions,
  • Diagnoses allowable for Ambulance,
  • Documentation requirements,
  • Frequency limitations,
  • Hospital discharge - Bypass PA
  • NDC information,
  • Prior authorizations and medical conditions that may bypass these requirements,
  • Rate information,
  • Required modifiers,
  • Supplies/DME - per diem, and
  • Tooth number and surface requirements.

To request or view upcoming training sessions please refer to the Michigan Department of Health and Human Services website at>>Training>>Medicaid Provider Trainings.

Any questions should be directed to Provider Inquiry, Michigan Department of Health and Human Services, phone toll-free 800-292-2550 or email at

Emergency Transports Diagnosis Codes Database - PDF  XLS



NOTE:  Effective for dates of service (DOS) on/after April 1, 2007, Hospital-Owned Ambulance services are reimbursed under the MDHHS Outpatient Prospective Payment System (OPPS).  While fees indicated in the MDHHS Ambulance Services Database apply to ambulance services, claims submitted by hospital-owned ambulance providers for DOS on/after April 1, 2007, must be submitted on the institutional claim format.  Please refer to the Outpatient Hospital provider web page for additional information and reference.