Place of Service Codes
The following place of service codes apply to ambulance transports:
• Ambulance – Land 41
• Ambulance – Air or water 42
Payment for ambulance services is based on the zip code at the point of pickup. The five-digit zip code determines both the applicable GPCI and whether a rural adjustment applies. When billing for round trip transports, you may submit both legs of the trip on one (1) CMS-1500 claim form if the point of pickup zip code is the same for both legs of the trip. If the zip code is different, you must submit the trips on separate claim forms.
For points of pickup outside of the United States or in United States territorial waters, suppliers should report the point of pickup zip code according to the following:
• For ground or air transport outside of the United States to a drop off outside of the United States (in Canada or Mexico), use the closest United State zip code to the point of pickup.
• For water transport from the territorial waters of the United States to the United States, use the zip code of the port of entry.
• For ground transport from Canada or Mexico to the United States, use the zip code at the United States border at the point of entry into the United States.
• For air transport from areas outside the United States to the United States, use the zip code at the United States border at the point of crossing into the US.