Ambulance services are billed to Medicare using HCPCS codes; the specific ambulance codes Medicare covers are listed in the Ambulance Fee Schedule. Ambulance Fee Schedules are updated annually. The codes in use between 2006 and 2017 are listed as a quick guide, but the authoritative references are the Ambulance Fee Schedules for each year of interest.
|A0425||Ground mileage, per statute mile|
|A0426||Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)|
|A0427||Ambulance service, advanced life support, emergency transport, level 1 (als1-emergency)|
|A0428||Ambulance service, basic life support, non-emergency transport, (bls)|
|A0429||Ambulance service, basic life support, emergency transport (bls-emergency)|
|A0430||Ambulance service, conventional air services, transport, one way (fixed wing)|
|A0431||Ambulance service, conventional air services, transport, one way (rotary wing)|
|A0432||Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers|
|A0433||Advanced life support, level 2 (als 2)|
|A0434||Specialty care transport (sct)|
|A0435||Fixed wing air mileage, per statute mile|
|A0436||Rotary wing air mileage, per statute mile|
Claims for ambulance transports are found in the Carrier and the Outpatient claims data. One ambulance trip will generate either a Carrier or an Outpatient claim, but not both. Claims submitted by hospital-based ambulance providers are found in the Outpatient claims data. Claims from non-hospital-based ambulance providers are found in the Carrier data. Approximately 95% of ambulance claims are located in the Carrier data.
It is possible for a patient to have multiple ambulance trips on one day. At least 20% of ambulance billing includes multiple trips for a beneficiary on one date. The most common scenario is transportation to and from an ESRD facility. Multiple trips may be billed on one claim, or there may be separate claims for each trip.
Ambulance claims contain origin and destination HCPCS modifier codes. The first position of the modifier code is the point of origin and the second position is the destination:
D = Diagnostic or therapeutic site other than P or H when these are used as origin codes
E = Residential, domiciliary, custodial facility (other than 1819 facility)
G = Hospital-based ESRD facility
H = Hospital
I = Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport
J = Freestanding ESRD facility
N = Skilled nursing facility
P = Physician’s office
R = Residence
S = Scene of accident or acute event
X = Intermediate stop at physician’s office on way to hospital (destination code only)
For example, “RH” indicates a patient was transported from a residence to the hospital. “HR” indicates the patient was transported from a hospital to a residence. “HH” indicates the patient was transported from one hospital to another. These modifiers can be useful to identify multiple trips in one day when the origin and destination codes of each trip are different.