Methodology for calculating qualifying payment amount.

# (a)

For further guidance see § 54.9816-6T(a) introductory text through (a)(17).

(1)-(17) [Reserved]

(18) Downcode means the alteration by a plan or issuer of a service code to another service code, or the alteration, addition, or removal by a plan or issuer of a modifier, if the changed code or modifier is associated with a lower qualifying payment amount than the service code or modifier billed by the provider, facility, or provider of air ambulance services.

# (b)

For further guidance see § 54.9816-6T(b) and (c).

# (c)

For further guidance see § 54.9816-6T(b) and (c).

# (d)

For further guidance see § 54.9816-6T(d) introductory text through (d)(1)(i).

(1) [Reserved]

(i) [Reserved]

(ii) If the qualifying payment amount is based on a downcoded service code or modifier—

(A) A statement that the service code or modifier billed by the provider, facility, or provider of air ambulance services was downcoded;

(B) An explanation of why the claim was downcoded, which must include a description of which service codes were altered, if any, and a description of which modifiers were altered, added, or removed, if any; and

(C) The amount that would have been the qualifying payment amount had the service code or modifier not been downcoded.

(iii) For further guidance see § 54.9816-6T(d)(1)(iii) through (v).

(iv) For further guidance see § 54.9816-6T(d)(1)(iii) through (v).

(v) For further guidance see § 54.9816-6T(d)(1)(iii) through (v).

(2) For further guidance see § 54.9816-6T(d)(2).

# (e)

For further guidance see § 54.9816-6T(e) and (f).

# (f)

For further guidance see § 54.9816-6T(e) and (f).