Ambulance Services: Multiple Transports on Same Day

Multiple trips for a single patient may occur in one day. Ambulance providers should bill such claims as indicated below.

  • Multiple trips may be billed on one claim when all Point of Pickup (POP) zip codes are the same
  • A separate claim for each trip must be billed when POP zip codes are different
  • Include narrative/comment in Item 19 of CMS-1500 form or its equivalent which provides condensed reason why (up to 80 characters) multiple trips were necessary
    • Narrative example: 8:15 a.m. returned home from hospital, 4:30 p.m. second transport same day

Providers may request a Redetermination if second claim denies as duplicate

Scenarios

Only one transport is allowed when both Advanced Life Support (ALS)/Basic Life Support (BLS) entity respond to a call

  • Let's say BLS transports after ALS assessment furnished; whoever transports bills Medicare  
  • Transporting ambulance must obtain all medical record documentation

When an agreement exists amongst the two entities

  • BLS may bill using an ALS1 rate
  • Medicare pays BLS entity at an ALS1 rate
  • Medicare does not regulate compensation between the two (ALS/BLS)

When no agreement exists

  • Only BLS level may be billed by BLS
  • Unless transport was beyond BLS scope, ALS services will not be covered

 

Last Updated Mon, 21 Nov 2022 18:38:10 +0000