Hospital-Based Ambulance Billing Guide

Description Hospital-Based Ambulance Claims

Type of Bill

13X/85X

Condition Codes

  • 20 - Billing for denial notice (if applicable)
  • AK - Air Ambulance Required
  • AL - Specialized Treatment/Bed Unavailable (transported to alternate facility)
  • AM - Non-Emergency Medically Necessary Stretcher Transport Required
  • B2 - Critical Access Hospital (CAH) Ambulance Attestation (Attestation by CAH that it meets the criteria for exemption from the ambulance fee schedule)

Value Codes

  • 32 - Multiple Patient Ambulance Transport
  • Report this code and the total number of patients transported if more than one patient is transported in a single ambulance trip.
  • A0 - Special ZIP Code Reporting
  • This code is used to report the ZIP code of the location from which the beneficiary is initially placed on board the ambulance.

Revenue Codes

  • 0540
  • Non-covered: 541, 542, 544, 547, 549

HCPCs Codes

  • A0426 - Ambulance service, Advanced Life Support (ALS), non-emergency transport, Level 1
  • A0427 - Ambulance service, ALS, emergency transport, Level 1
  • A0428 - Ambulance service, Basic Life Support (BLS), non-emergency transport
  • A0429 - Ambulance service, basic life support (BLS), emergency transport
  • A0430 - Ambulance service, conventional air services, transport, one way, fixed wing (FW)
  • A0431 - Ambulance service, conventional air services, transport, one way, rotary wing (RW)
  • A0432 - Paramedic Intercept, rural area volunteer ambulance
  • A0433 - Ambulance service, advanced life support, level 2 (ALS2)
  • A0434 - Ambulance service, specialty care transport (SCT)
  • A0425 - BLS/ALS mileage, per statue mile
  • A0435 - Air mileage; FW, (per statute mile)
  • A0436 - Air mileage; RW, (per statute mile)
  • A0888 - Mileage Beyond the Nearest Facility

 

Non-covered:

  • A0021 - A0424 and A0998

Modifiers

Origin & Destination Codes:

  • D - Diagnostic or therapeutic site other than P or H when these are used as origin codes
  • E - Residential, domiciliary, custodial facility
  • G - Hospital based ESRD facility
  • H - Hospital
  • I - Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport
  • J - Freestanding ESRD facility
  • N - Skilled nursing facility
  • P - Physician's office
  • R - Residence
  • S - Scene of accident or acute event
  • X - Intermediate stop at physician's office on way to hospital (destination code only)

 

In addition, institutional-based providers must report one of the following modifiers with every HCPCS code to describe whether the service was provided under arrangement or directly:

  • QM - Ambulance service provided under arrangement by a provider of services or
  • QN - Ambulance service furnished directly by a provider of service

 

Modifiers used when billing non-covered services:

  • GA - ABN on file (Rarely used - only used in non-emergency situation)
  • GY - Service statutorily excluded or does not meet definition of Medicare benefit
  • QL - Patient pronounced dead after ambulance called

Line Item Date of Service

MM/DD/YY

Units of Service

Report 1 unit with HCPCs codes A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434

 

Report number loaded miles with HCPCs codes A0425, A0435 or A0436. Mileage must be reported as fractional units

  • Miles totaling less than 100 miles: Report mileage units rounded up to nearest tenth of a mile. Submit fractional mileage using a decimal in appropriate place (e.g., 99.9). Mileage units reported as 99.99 will become 99.9
  • Miles totaling 100 miles or greater: Report mileage rounded up to nearest whole number mile. Note: Contractors will truncate mileage units totaling 100 and greater that are reported with fractional mileage (e.g., 100.99 will become 100 after truncating the decimal places)
  • Mileage totaling less than 1 mile, include a "0" prior to decimal point (e.g., 0.9)

Total Charges

For line items reflecting HCPCS codes A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434, providers report the actual charge for the ambulance service including all supplies used for the ambulance trip but excluding the charge for mileage.

 

For line items reflecting HCPCS codes A0425, A0435, or A0436, providers are to report the actual charge for mileage.

 

When there is no cost incurred for mileage, enter $1.00.

Non-Covered Charges

Enter amount of non-covered services, if applicable

Diagnosis

Codes

Not required. Condition of the patient can be reported with ICD-9 codes.

NPI

CR 7557

Effective for services furnished on or after 4/1/12:

  • Only non-emergency trips (HCPCS A0426, A0428) require an NPI in the Attending Physician field.
  • Emergency trips do not require an NPI in the Attending Physician field (A0427, A0429, A0430, A0431, A0432, A0433, A0434)

Payment

Fee schedule. Add-on in rural areas and Super Rural Bonus when applicable. Exception to fee schedule: CAH ambulance claims reporting condition code B2 to attest that there is no other provider or supplier of ambulance services that is located within a 35-mile drive of the CAH. Eligible CAHs will be paid 101% of reasonable cost.

 

Last Updated Mon, 09 Apr 2018 14:58:23 +0000