Tuesday, October 12, 2010

CPT code A0426 - non emergency transport

HCPCS A0426 – Ambulance service, ALS1, non-emergency transport, specialized ALS services, all inclusive

Advanced Life Support, Level 1 (ALS1) Non-emergency - ALS1 is transportation by ground ambulance vehicle, and the provision of, medically necessary supplies and services including an ALS assessment by ALS personnel or at least one ALS intervention.

Advance Life Support Assessment – An ALS assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient’s reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires ALS level of service.

The determination to respond emergently with an ALS ambulance must be in accord with the local 911 or equivalent service dispatch protocol. If the call came in directly to the ambulance supplier, then the supplier’s dispatch protocol must meet, at a minimum, the standards of the dispatch protocol of the local 911 or equivalent service. In areas that do not have a local 911 or equivalent service, then the protocol must meet, at a minimum, the standards of a dispatch protocol in another similar jurisdiction within the State or, if there is no similar jurisdiction within the State, then the standards of any other dispatch protocol within the State. Where the dispatch was inconsistent with this standard of protocol, including where no protocol was used, the beneficiary’s condition (for example, symptoms) at the scene determines the appropriate level of payment.

Advance Life Support Personnel – Advance Life Support personnel is an individual trained to the level of the emergency medical technician-intermediate (EMT-Intermediate) or paramedic.

• The EMT-Intermediate is defined as an individual who is qualified, in accordance with State and local laws, as an EMT-Basic and who is also certified in accordance with State and local laws to perform essential advanced techniques and to administer a limited number of medications
• The EMT-Paramedic is defined as possessing the qualifications of the EMT-Intermediate and in accordance with State and local laws, possesses enhanced skills including the ability to administer additional interventions and medications.

Advance Life Support Intervention – Advanced life support (ALS) intervention is a procedure that is, in accordance with State and local laws, required to be performed by an emergency medical technician-intermediate (EMT-Intermediate) or EMT-Paramedic. An ALS intervention must be medically necessary to qualify for payment as an ALS level of service. An ALS intervention applies only to ground transports.

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