Community Paramedic Services

Eligible Providers

A community paramedic or emergency medical technician-community paramedic (EMT-CP) must have the following:

1. Certification by the Minnesota Emergency Medical Services Regulatory Board (EMSRB)
2. Employment by a PrimeWest Health-enrolled ambulance service
3. A service scope agreement, based on the paramedic’s skills, with the medical director of the ambulance service

To obtain a community paramedic certificate from the EMSRB, an applicant must have completed the following:

1. A current paramedic certification of EMT-P
2. Two years of full-time services as an EMT-P
3. Graduation from an accredited course

As stated in MN Stat. sec. 144E.28, subd. 9:

(a) To be eligible for certification by the board as a community paramedic, an individual shall:

(1) Be currently certified as a paramedic and have two years of full-time service as a paramedic or its part-time equivalent;

(2) Successfully complete a community paramedic education program from a college or university that has been approved by the board or accredited by a board-approved national accreditation organization. The education program must include clinical experience that is provided under the supervision of an ambulance medical director, advanced practice registered nurse, physician assistant, or public health nurse operating under the direct authority of a local unit of government; and

(3) Complete a board-approved application form.

(b) A community paramedic must practice in accordance with protocols and supervisory standards established by an ambulance service medical director in accordance with section 144E.265. A community paramedic may provide services as directed by a patient care plan if the plan has been developed by the patient's primary physician or by an advanced practice registered nurse or a physician assistant, in conjunction with the ambulance service medical director and relevant local health care providers. The care plan must ensure that the services provided by the community paramedic are consistent with the services offered by the patient's health care home, if one exists, that the patient receives the necessary services, and that there is no duplication of services to the patient.

Eligible Members

All PrimeWest Health members who do not reside in a Skilled Nursing Facility (SNF) are eligible for community paramedic services.

Community paramedics assist in the care of members who receive hospital emergency department services three or more times in four consecutive months within a 12-month period or who meet one or more of the following criteria:

1. Are identified by their primary care provider as at risk of nursing home placement
2. May require set up of services for discharge from a nursing home or hospital
3. May require services to prevent readmission to a nursing home or hospital

Covered Services

Services provided by certified community paramedics must be a part of a care plan ordered by a primary care provider (physician, advanced practice registered nurse (APRN), or physician assistant) in consultation with the ambulance medical director. The care plan must ensure that the services provided by community paramedics are coordinated with other community health providers and local public health agencies and are not duplicate services, including home health and waiver services. Community paramedics providing services to members receiving care coordination must consult with the care coordinators.

Upon Federal approval and pursuant to MN Stat. sec. 256B.0625, subd. 60, community paramedic services include the following:

1. Health assessments
2. Chronic disease monitoring and education
3. Medication compliance
4. Immunizations and vaccinations
5. Laboratory specimen collection
6. Hospital discharge follow-up care
7. Minor medical procedures approved by the ambulance medical director

Non-Covered Services

The following services are not covered:

1. Travel time
2. Mileage
3. Facility fee
4. Services related to hospital-acquired conditions or treatments

Documentation Requirements

Keep complete documentation on file.

Community Paramedic Billing

Refer to Claims & Payment for general PrimeWest Health billing policies. Submit claims electronically using the 837P format.

1. In the “Treating Provider” field, enter the medical director’s National Provider Identifier (NPI).
2. Enter the clinic, hospital, or ambulance service’s NPI/Unique Minnesota Provider Identifier (UMPI)
3. Use code T1016 with modifier U3.
4. Bill in 15-minute increments (one unit = 15 minutes).
5. More than half the time (eight minutes) must be spent performing the service face-to-face in order to report a 15-minute unit.
6. Bill supplies primary to the encounter separately. Supplies used by the community paramedic in direct relationship to the illness or injury are considered incidental to the service and not separately billable to PrimeWest Health.

PW_11-19_599
Updated_11/20/2023