Ambulance Part B Billing

Access the below ambulance billing related information from this page.

Overview

  • HCPCS billed must reflect type of service the beneficiary received, not vehicle used
  • All ambulance suppliers must accept assignment
    • Provider will recieve 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 requred 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

 

Last Updated Wed, 28 Jul 2021 17:46:43 +0000