Ambulance Transportation Billing ServicesMedical Coding

Medicare requirements for ambulance transport medical billing

Today various private and public ambulance transport services are operating in a huge number for servicing critical patients at crucial moments. These players are getting reimbursed under Medicare Part B which covers ambulance transport medical billing with certain limitations.

Let’s understand Medicare Part B in more details:

Medicare Part B

Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by other means. If your trip is scheduled when your health is not in immediate danger, it is not considered an emergency.

Eligibility Criteria

Part B covers emergency ambulance services if:

  • When the ambulance is the only safe way to transport you also known as (medically necessary).
  • By following Medicare’s coverage guidelines, the patient is transported to/from a certain location.
  • Medicare ambulance requirements are met by transport suppliers.

Part B covers non-emergency ambulance services if:

  • The patient is unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair.
  • Or need vital medical services during your trip that are only available in an ambulance.

You may find that Medicare may cover unscheduled or irregular non-emergency trips if you live in a skilled nursing facility (SNF) and you have a doctor’s written order within 48 hours after the transport. Moreover, Medicare may also cover scheduled, regular trips if the ambulance supplier receives a written order from your doctor ahead of time stating that transport is medically necessary.

All insurance companies including Medicare and Medicaid pay for ambulance and emergency services. However, you will find ambulance transport medical billing is complicated due to need for the unique and detailed modifiers and the various modes of transport include ground, water, fixed-wing, and rotary-wing.

Take a look at the following CPT codes and various modifiers used in ambulance transport medical billing:

CPT codes and reimbursement for ambulance transport medical billing

For reimbursement of ambulance transport medical billing, healthcare providers should record correct clinical documentation and later coding and billing are strictly based on this recorded documentation. When it comes to coding you will find eight categories of ground ambulance services which include both land and water transportation.

The codes must be selected based on the patient’s condition and services provided at the time of transport.

The following CPT codes are available for ambulance transport:

CPT Code

Description

A0425 Ground mileage, quantity is per mile, and the reimbursement for mileage is generally based on the insurance company’s perception of who is the closest appropriate provider
A0426 Advanced Life Support Level 1, Non-Emergency
A0427 Advanced Life Support Level 1, Emergency
A0428 Basic Life Support, Non-Emergency
A0429 Basic Life Support, Emergency
A0432 Paramedic Intercept
A0433 Advanced Life Support Level 2, Emergency or Non-Emergency
A0434 Specialty Care Transport

Modifiers used for ambulance transport medical billing:

Two characters of Modifiers show origin and destination where first is used for the origin and second for the destination.  Some of the available modifiers include, but are not limited to:

Modifier

Description

D  Diagnostic or therapeutic site
E Residential, domiciliary, or custodial facility
G Hospital-based dialysis facility
H Hospital
I Site of transfer between modes of transport
J Non-hospital based dialysis center
N Skilled nursing facility
P Physician’s office
R Residence
S Scene of accident
X Intermediate stop at physician’s office en route to the hospital.

Second modifiers for ambulance transport medical billing:

Here some second modifiers are present which are included after the origin and destination modifier. These can include but are not limited to:

Modifier

Description

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

Are you still finding ambulance transport medical billing complicated? We are here to help you. We are a billing firm which helps ambulance providers appropriately optimize their reimbursement rates with the help of correct billing and coding accuracy, and improve revenue cycle processes.

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