Hospital-Based Ambulance Billing Guide - JE Part A

• 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)

• 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.

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

• 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

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

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)

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)