Ambulance Duplicate Denials - Appeals Newsletter Part 7

Are you getting duplicate denials for multiple trips for a single beneficiary the same day?

If all points of pickups are in the same zip code, they may be billed on the same claim.

If any of the points are in different zip codes:

  • Submit a separate claim for each zip code.
  • Item 19 (freeform text field) provide comments on multiple pickups
    • Example: 8:15 a.m. Transported to dialysis, 4:30 p.m. returned home from dialysis

If the second claim is denied as duplicate, submit a Redetermination. Only use GY modifier when the service is statutorily non-covered or is not a Medicare benefit.

Advanced Beneficiary Notice of Non-coverage cannot be presented in an emergency.


Last Updated Apr 03 , 2024