Ambulance billing is a mechanism that allows hospitals to recoup the costs of emergency medical services connected with transferring a patient to the hospital via ambulance.
There are special sets of:
- 12 Level of service codes
- 11 Origin and destination modifiers
- 5 Signature requirement exceptions
- 31 Advanced Life Support condition codes
- 3 Advanced Life Support non-emergency condition codes
- 11 Basic Life Support non-traumatic condition codes
- 8 Basic Life Support traumatic condition codes
- 10 Basic Life Support non-emergency condition codes
- 11 Transportation indicator codes
|Group 1 Codes||Description|
|A0425||GROUND MILEAGE, PER STATUTE MILE|
|A0426||AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS 1)|
|A0427||AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 – EMERGENCY)|
|A0428||AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT, (BLS)|
|A0429||AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)|
|A0430||AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (FIXED WING)|
|A0431||AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING)|
|A0432||PARAMEDIC INTERCEPT (PI), RURAL AREA, TRANSPORT FURNISHED BY A VOLUNTEER AMBULANCE COMPANY WHICH IS PROHIBITED BY STATE LAW FROM BILLING THIRD PARTY PAYERS|
|A0433||ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)|
|A0434||SPECIALTY CARE TRANSPORT (SCT)|
|A0435||FIXED WING AIR MILEAGE, PER STATUTE MILE|
|A0436||ROTARY WING AIR MILEAGE, PER STATUTE MILE|
Fee Schedule for Ambulances
The fee schedule applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers, such as hospitals, critical access hospitals (except when it is the only ambulance service within 35 miles), and skilled nursing facilities, for claims with dates of service on or after April 1, 2002.
The Centers for Medicare & Medicare Services (CMS) will require some ground ambulance organisations to collect and report cost, revenue, utilisation, and other data through the Medicare Ground Ambulance Data Collection System beginning January 1, 2022. (GADCS).
Ambulance services are covered by Medicare Part B; however, the Medicare beneficiary can only use this service if the following conditions are met.
1. The Beneficiary’s Actual Transportation Occurs In The Situation.
2. The Beneficiary Is Delivered To The Correct Location.
3. The beneficiary’s condition should be such that any other mode of transportation would be fatal.
4. The provider must meet all of the necessary criteria, such as vehicle, staffing, and transportation equipment.
5. Transportation Will Never Be Provided As Part Of Medicare Part A.
Payment Rules for Ambulance Transportation Billing
Medicare-covered ambulance services are reimbursed using the Medicare Ambulance Fee Schedule, which can be found here.
1. A separate base payment and mileage payment should be made.
2. The service provider should cover the beneficiary’s transportation to the closest facility as well as other items and services related to transportation.
3. Payment for items used and service should not be separated.
Modifiers for the Ambulance Claim
Modifiers for ambulance services are formed by combining two alpha characters with significantly different origins and destinations. With the exception of X, which represents the origin or destination code, each alpha letter begins with an X.
The following are the origin and destination codes, as well as their descriptions:
|D||Diagnostic or Therapeutic Site Other Than P or H When These Are Used As Origin Codes;|
|E||Residential, Domiciliary, Custodial Facility (Other Than 1819 Facility);|
|G||Hospital Based ESRD Facility;|
|I||Site Of Transfer (E.G. Airport or Helicopter Pad) Between Modes Of Ambulance Transport;|
|J||Freestanding ESRD Facility;|
|N||Skilled Nursing Facility;|
|S||Scene of Accident or Acute Event;|
|X||Intermediate Stop At Physician’s Office On Way To Hospital (Destination Code Only)|