Ambulance Transports: Levels of Service

Ambulance payment is based on the level of service furnished (if medically necessary), not simply on the vehicle used.

Air Ambulance

Ground Ambulance

Basic Life Support (BLS)

BLS is transportation by ground or water ambulance vehicle and includes the provision of medically necessary supplies and services and BLS transportation as defined by the State where the transport is provided.

Laws may vary from State to State. For example, in some jurisdictions, an EMT-Basic permitted to:

  • Operate limited equipment onboard the vehicle
  • Assist more qualified personnel in performing assessments and interventions
  • Establish peripheral intravenous (IV) line

Applicable HCPCS Codes

  • A0428: BLS non-emergency transport
  • A0429: BLS emergency transport

Advanced Life Support, Level 1 (ALS1)

ALS includes the provision of medically necessary supplies and services and the provision of an ALS assessment or at least one ALS intervention (procedure performed by an EMT-Intermediate or an EMT-Paramedic in accordance with State and local laws).

The assessment is performed by the crew as part of an emergency response. This is necessary as the beneficiary's reported condition, at the time of dispatch, indicates that only an ALS crew is qualified to perform this assessment.

The result of an assessment does not necessarily determine that he/she requires this level of transport.

When dispatched appropriately and the ALS crew completes the assessment, the ambulance services provided are covered at this level as long as the transportation itself is medically reasonable and necessary and all coverage requirements are met.

Applicable HCPCS Codes

  • A0426: ALS1 non-emergency transport
  • A0427: ALS1 emergency transport

Advanced Life Support, Level 2 (ALS2)

Includes the provision of medically necessary supplies and services, which include:

  • At least three separate administrations of one or more medications by intravenous (IV) push/bolus or by continuous infusion (excluding crystalloid fluids) or
  • At least one of following ALS2 procedures: Manual defibrillation/cardioversion, Endotracheal intubation, Central venous line, Cardiac pacing, Chest decompression, Surgical airway, or Intraosseous line

The following does not determine and ALS2 Medications (oral, injections, nebulized), crystalloid fluids, 5% dextrose in water (D5W), saline, lactated ringers, oxygen, and aspirin.

Applicable HCPCS Code

  • A0433: ALS2 (3 separate medications by IV)

Fixed Wing and Rotary Wing

A beneficiary may be transported by fixed wing (airplane) or rotary wing (helicopter) aircraft for a medically necessary air ambulance transport.

Specialty Care Transport (SCT)

Includes the provision of medically necessary supplies and services at a service level above the scope of an EMT-P.

This type of transport occurs when a critically ill or injured beneficiary is transported from one medical facility to another because his/her condition requires ongoing care furnished by one or more professionals in an appropriate specialty (such as emergency or critical care nursing, emergency medicine, respiratory or cardiovascular care, or an EMT-paramedic with additional training).

If EMT-Paramedics are without specialty care certification or qualification and are permitted to furnish a given service in a state, then that service does not necessarily qualify for SCT and may be downcoded to a lower level.

Applicable HCPCS Code

  • A0434: SCT

Paramedic Intercept (PI)

  • Does not apply to Noridian providers - New York state only


Last Updated Dec 09 , 2022