Ambulance Transportation CPT Codes and Modifiers

Ambulance transportation services that are covered in Medicare part B covers ground ambulance transportation when a patient needs to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services while the transportation in another vehicle could be hazardous for patient’s health. However, ambulance transportation has certain risks.

The risk involved in Ambulance transportation

Emergency Medical Services (EMS) is included in Ambulance and patient transport services while private ambulance services which supply various services such as emergency prehospital care, basic medical support and roadside transport to hospitals for patients experiencing medical emergencies, However, ambulance transportation has certain risk such as high speeds and the use of lights, sirens, which potentially results in ambulance crashes that may injure or cause the death of patients, providers, pedestrians.

To make ambulance transport safer various guidelines are currently being developed

  • Drive cautiously at safe speeds, observing traffic laws,
  • Encourage the utilization of the Department of Transportation National Highway Traffic Safety Administration Emergency Vehicle Operating Course (EVOC), and National Standard Curriculum

An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call and emergency ambulance services are provided after the sudden medical condition.

Role of Emergency Medical Technician for prehospital ambulance transport

Generally, hospitalists directly interact with ambulance transport teams who have picked patients up from their homes or other nonmedical settings and brought them to the hospital. But an emergency medical technician (EMT) may be the primary provider on prehospital ambulance transport.

EMTs are typically undergone approximately 40 to 100 hours of medical training in which a small portion may be pediatric. Moreover, These EMTs have limited assessment and interventional capabilities, also local statutes govern what procedures EMTs can perform during transport.

While a higher level of EMS transport involves paramedics who have approximately 1 year of medical training and usually at least 16 hours and a limited practicum involving pediatrics.

Reimbursement for Ambulance services

All insurance companies including Medicare and Medicaid pay for ambulance and emergency services. However, the unique and detailed modifiers and the various modes of transport include ground, water, fixed-wing, and rotary-wing make coding and billing for ambulance transportation services complicated.

Healthcare providers should record correct clinical documentation during the case for reimbursement. Moreover, coding and billing are strictly based on this recorded documentation, so the documentation must be complete and accurate.

CPT codes that are used in ambulance transportation billing are relatively low but we can witness various unique modifiers and the complicating factors which have a significant impact on reimbursement.

The CPT codes for ambulance Transportation:

There are seven categories of ground ambulance services which include both land and water transportation. The selection of codes is based on the patient’s condition at the time of transport as well as services rendered.

A0425 Ground mileage, per statute mile

A0426 Ambulance service, (ALS), non-emergency transport (Level 1)

A0427 – ALS (Level 1), Emergency

A0428 – Basic Life Support, Non-Emergency

A0429 – Basic Life Support, Emergency

A0433 –Advanced life support, level 2 (ALS2)

A0434- Specialty Care Transport (SCT)

Now, let’s look at some modifiers as these modifiers are two characters that represent origin and destination, and they are designed to show first the origin and second the destination:

Some of the modifiers for Ambulance Transportation

D –Diagnostic or therapeutic site excluded P or H when these are used as origin codes

E- Residential, domiciliary, custodial facility excluded 1819 facility

G –Hospital-based ESRD facility

H –Hospital

I –Site of transfer between modes

J –Freestanding ESRD facility

N Skilled nursing facility

P Physician’s office

R Residence

S Scene of accident or such acute event

X Intermediate stop at physician’s office along the way to the hospital

Some second modifiers for Ambulance Transportation

Now let’s look at some second modifiers to be included after the origin and destination modifier. These can include but are not limited to:

CR – Related to a catastrophe or declared disaster

GA – ABN was required and obtained

GM – Multiple patient modes of transport

GW – Hospice patient, unrelated to the hospice diagnosis

GX – ABN was optional and obtained

GY – Service that is statutorily excluded

GZ – ABN was required but not obtained

QJ – Incarcerated patient

QL – Patient pronounced dead after ambulance called

QM – Under the arrangement

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