Billing - JE Part B

Access the below ambulance billing related information from this page.

• Beneficiary Death
• Claim Form Item Details
• Fees/Reimbursement
• Ground Ambulance Services: Waiver for Treatment in Place
• Mileage
• Modifiers
• Multiple Beneficiary Transport
• Multiple Transports Provided on One Date of Service
• Overview
• Resources
• Services Provided Outside the United States
• Transport Refusal

Overview

• HCPCS billed must reflect type of service the beneficiary received, not vehicle used
• All ambulance suppliers must accept assignment
  • Provider will receive Medicare check, not the beneficiary
  • Provider must accept Medicare allowable as payment
• Providers are only able to bill a patient for unmet Part B deductible, Part B coinsurance and non-covered charges
• Cannot unbundle some non-covered costs (e.g. oxygen)
• Ambulance services has its own fee schedule

Claim Form Item Details for Ambulance Services

Although all applicable CMS-1500 claim (or electronic equivalent) Items are required for completion and submission, the details below provide the general ambulance related information required within a claim.

• Item 19:
  • Provide EMT/Paramedic interface with patient, include brief narratives (ex. Blood pressure, chest pain, dizziness, etc.)
  • If transport went beyond "closest facility," briefly indicate why
• Item 21: Enter up to 12 diagnoses - Even though EMTs/Paramedics don't diagnose, use condition codes and ICD-10
• Item 23: Zip code for point of pickup (POP) - Used for pricing
• Item 24B: Place of service 41 (ground) or 42 (air)
• Item 24D: HCPCS base, mileage rate and origin/destination modifiers
  • If unrelated to Hospice, append GW modifier
  • If related to Hospice, bill Hospice
• Item 24G: Base rate NOS (always 1), Patient loaded miles
• Item 24J: Not required for ambulance suppliers
• Item 32:
  • Ambulance suppliers required to submit both origination and destination information
  • Enter Originating site information (Providers name of facility (street address not required), city, state and zip code)
    • If not enough space for destination information, include in Item 19
• Item 32A: Service location NPI not necessary as all above is included

Resources

• Billing
  • CMS Internet Only Manual (IOM), Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 1 - General Overview
  • CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Publication, Chapter 10 - Ambulance Services
  • CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1 - General Billing Requirements
  • CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 15 - Ambulance
  • CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 26 - Completing and Processing Form CMS-1500 Data Set
• CMS Change Request (CR) 7489 - Instructions to Accept and Process All Ambulance Transportation HCPCS Codes
• CR 6700 - Ensuring the Denial of Claims for Ambulance Services Rendered to Beneficiaries in Part A SNF Stays
• OIG Report: Medicare Paid Twice for Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing Requirements