Medicare Carrier and Outpatient Files: Identifying Ambulance Services

Use of the Ambulance Fee Schedule

Medicare Carrier and Outpatient Files: Identifying Ambulance Services

Current Version Date: 
01/31/2017

Billing for ambulance services

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 below as a quick guide, but the authoritative references are the Ambulance Fee Schedules for each year of interest.  

 

Table 1: Codes to Bill Ambulance Services, 2006-2017

HCPCS Code

Description

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 files

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.

 

Components of ambulance billing

There are two components of ambulance billing:

  • The service
  • The mileage

An individual claim will contain a HCPCS code for the service and a HCPCS code for the mileage. This means there will be at least two line items (Carrier) or two revenue center (Outpatient) records submitted for each ambulance claim.

 

Multiple trips on one day

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. ,

 

HCPCS modifiers specific to ambulance services

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.

For additional information regarding the billing of ambulance services, including the billing of multiple trips in one day, please see:

CMS Ambulance Services Center

Ambulance chapter of the Medicare Claims Processing Manual

Article Number: 
143
Author(s): 
This work was performed under CMS Contract Number HHSM-500-2005-00027I.

Disclaimer

The process and materials mentioned as part of this KnowledgeBase article are current, as of the publication date on the article, to the best of our knowledge. The examples provided are correct in the aggregate but may not apply to every subgroup or circumstance that a researcher may wish to study. It is up to the researcher to conduct analysis and confirm that the patterns described in this KnowledgeBase article apply to his/her particular study. If your research findings appear to contradict the advice provided, please contact ResDAC at resdac@umn.edu.