Beginner’s Guideline For Ambulance Transportation Billing - Medical Billers and Coders

Ambulance transportation is one of the most highly-priced services provided by the US healthcare and paid by Medicare. So it’s important that the Ambulance transportation service providers understand the basic guideline of ambulance transportation billing.

Ambulance services are covered under Medicare Part B, this service is available for the Medicare beneficiary only if the following required conditions are met:

  • Actual Transportation Of Beneficiary Occurs In The Condition.
  • The Beneficiary Is Transported To An Appropriate Destination.
  • The Condition Of The Beneficiary Should Be Such That Other Modes Of Transportation Could Prove Fatal.
  • The Provider Should Meet All The Necessary Criteria For Example Vehicle, Staffing, Equipment For Transportation.
  • The Transportation Will Never Be A Part Of Medicare Part A Service.

Definition Of Implementation

A/B MAC (A) Definition: This refers to those contractors that process the claims for institutionally based ASC claim transactions or Form CMS-1450

A/B MAC (B) Definition: The term refers to those contractors that process claims for ambulance suppliers billed on the ASC X12 837professional claim transaction or a CMS-1500 form.

(Note the above definition refer only to the chapter)

Ambulance Services are separately reimbursable only under Medicare Part B. Once the beneficiary is admitted to a Critical Access Hospitals (CAH) or Skilled Nursing Facility (SNF) it might be necessary for the transport of beneficiary to the other specialized hospital. During the whole process, the beneficiary does maintain the inpatient status for the original provider.  

The transportation of such condition is considered as an inpatient hospital. For CAH it comes under Part A and for an SNF service, it is covered in the SNF service with Part A payment for the service.  The service is covered and payable under beneficiary transportation service under Part A, the service cannot be shifted under part B. Intra-campus transfer are not payable under Part-B. Such intra-campus transfer cost is accounted in the same manner as the cost of the single building.

The A/B MAC (A) is responsible for claim processing of ambulance services which is furnished by a hospital-based ambulance or for ambulance services provided by a supplier if provided by the supplier under the arrangements for an inpatient. The A/B MAC (B) is responsible for processing claim for suppliers for the entities that are not owned or operated by a provider.

Payment Rules For Ambulance Transportation Billing

Medicare-covered ambulance services are paid according to the Medicare Ambulance fee schedule. The below following sections provide an insight how the payment amount is calculated for ambulance transportation:

  • Should Have A Separate Base Payment And Payment For Mileage.
  • The Services Provider Should Cover The Beneficiary To Nearest Facility And All Items, Services Associated With Transportation.
  • Should Not Include Separate Payment For Items Used And Service Under The Ambulance Benefit.

For items and services, we have to include the fee schedule payment. Such items and services include everything but are not limited any object or service. They are both medically necessary and covered by Medicare under ambulance benefit. 

Components Of Ambulance Fee Schedule

For Ground Ambulance Service

  • A Money Amount That Serves A National Uniform Base Rate Is Called As A Conversion Factor For All Ground Ambulance Services.
  • Relative Value Unit (RUV) Assigned To Each Ground Ambulance Service.
  • A Geographic Adjustment Factor (GAF) For Each Ambulance Fee Schedule Locality Area.
  • An Additional Amount Of Certain Mileage For Rural Point-Of-Pickup.

For Air Ambulance Service

  • A Uniform Base Rate For The Wing And Nationally Base Rate For Rotary Wing.
  • Geographic Adjustment Factor (GAF) For Each Ambulance Fee Schedule Locality Area.
  • A Uniform Loaded Mileage Rate For The Air Service.
  • An Adjustment Base Rate And Mileage For Rural Point Of Use.

For Claims Outside U.S.

  • Ground transport that drops off and picks up patients within Canada or Mexico will be paid according to the closest U.S. Zip Code.
  • In case of water transport, the fee would be paid according to the port of entry for the U.S.
  • For those providers which make an entry.
  • Ground transports with pickup and drop off points within Canada or Mexico will be paid at the fee associated with the U.S. ZIP Code that is closest to the POP.

Modifiers For The Ambulance Claim

The origin and destination of modifiers for the ambulance services are created by combining two widely different alpha characters. Each of the alpha characters starts with an exception of X to represent origin code or destination code. The first position of alpha code equals origin and in the second position of alpha code equals destination.

Origin And Destination Codes And Their Descriptions Are Listed Below:

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)

Exploring the intricacies of Ambulance Billing is just the beginning. For a comprehensive understanding of the guidelines, delve into how our expert Medical Billers and Coders handle Ambulance Transportation billing. Visit our website or reach out to us at: 888-375-3226.

Published By - Medical Billers and Coders
Published Date - May-15-2018 Back

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