Transportation indicator C3 and C4 in ambulance billing

• Transportation Indicator “C3”: Transportation indicator “C3” may be included on claims as a secondary code where a response was made to a major incident or mechanism of injury. All such responses – regardless of the type of patient or patients found once on scene – are appropriately Advanced Level Service responses. A code that describes the patient’s condition found on scene should also be included on the claim, but use of this indicator is intended to indicate that the highest level of service available response was medically justified. Some examples of these types of responses would include patient(s) trapped in machinery, explosions, a building fire with persons reported inside, major incidents involving aircraft, buses, subways, trains, watercraft and victims entrapped in vehicles.

• Transportation Indicator “C4”: Transportation indicator “C4” indicates that an ambulance provided a medically necessary transport, but the number of miles on the claim form appears to be excessive. This should be used only if the facility is on divert status or a particular service is not available at the time of transport only. The provider or supplier must have documentation on file clearly showing why the beneficiary was not transported to the nearest facility and should include this information in the narrative field (NTE02) on the claim.

Example:
C2 -D/C from 1stfac ADM to 2ndfac 
For heart cath not available at 1stfac