Access the below ambulance billing related information from this page.

• Beneficiary Death
• Claim Form Item Details
• Fees/Reimbursement
• Mileage
• Modifiers
• Multiple Beneficiary Transport
• Multiple Transports Provided on One Date of Service
• Overview
• Resources
• Services Provided Outside the United States
• Transport Refusal

Overview

Medicare requires that HCPCS codes billed reflect the actual service provided, not the type of vehicle used. All ambulance suppliers must accept assignments, meaning Medicare pays the provider directly, and the provider must accept the Medicare-approved amount as full payment. Providers may only bill patients for applicable Part B deductibles, coinsurance, and any non-covered services, and they cannot unbundle non-covered items (such as oxygen) for separate billing. Ambulance services are reimbursed according to their own dedicated 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 required 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

• Billing
  • CMS Internet Only Manual (IOM), Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 1 - General Overview
  • CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Publication, Chapter 10 - Ambulance Services
  • CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1 - General Billing Requirements
  • CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 15 - Ambulance
  • CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 26 - Completing and Processing Form CMS-1500 Data Set
• OIG Report: Medicare Paid Twice for Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing Requirements