billing CPT a0430, a0431,A0435, A0436 - Air ambulance

Procedure Codes for Air Services

HCPCS A0430 – Ambulance service, conventional air services, transport, one way, fixed wing
Fixed Wing (FW) Air Ambulance – Fixed wing air ambulance is the transportation by an aircraft that is certified by the Federal Aviation Administration (FAA) as a fixed wing air ambulance including the provision of medically necessary services and supplies.

HCPCS A0431 – Ambulance service, conventional air services, transport, one way, rotary wing
Rotary Wing (RW) Air Ambulance – Rotary wing air ambulance is the transportation by a helicopter that is certified by the FAA as a rotary wing ambulance, including the provision of medically necessary supplies and services.

HCPCS A0435 – Fixed Wing air mileage – per statute mileage
HCPCS A0436 – Rotary Wing air mileage- per statute mileage




FIXED WING AIR AMBULANCE

Fixed wing air ambulance providers must submit a copy of their Aircraft Transport Operation license with the enrollment application to verify that their aircraft is registered as an Aircraft Transport Vehicle. Since all equipment standards must equate to current Basic Life Support (BLS) or Advanced Life Support (ALS) criteria, as appropriate for the transported patient, providers must also submit a copy of their Commission on Accreditation of Medical Transport Systems (CAMTS) accreditation or an affidavit of substantial CAMTS accreditation compliance to document that the fixed wing aircraft is
suitable for air ambulance transport. The Medicaid Provider Enrollment file reflects enrollment as a fixed wing air ambulance provider.

Air ambulance transport and mileage provided by fixed wing aircraft must be prior authorized. (For details regarding prior authorization [PA] for out of state services, refer to the Out of State Nonborderland Transports subsection in this chapter.)
The following requirements must be met:

* The transport, including ancillary services (e.g., flight nurse), is ordered by a physician;

* The written physician order is maintained in the beneficiary's file;

* Transport by a ground vehicle would endanger the beneficiary's life due to time and distance from the hospital;

* Necessary care and medical services for the beneficiary's condition cannot be provided by the local facility; and

* Transport is for medical or surgical procedures only and not for diagnostic purposes.



HELICOPTER AIR AMBULANCE

Helicopter air ambulance providers must submit a copy of their license with their enrollment application. The Medicaid Provider Enrollment file reflects enrollment as a helicopter air ambulance provider.

MDHHS covers helicopter air ambulance services only under the following circumstances:

* Time and distance in a ground ambulance would be a hazard to the life of the patient.

* Necessary care and services for the beneficiary's needs are not available at the local hospital.

* Transport is for medical or surgical procedures only and not for diagnostic purposes.



Coverage of helicopter air ambulance services includes the helicopter base rate, mileage, and waiting time:

* Base Rate: Reimbursement for the helicopter air ambulance base rate includes oxygen, equipment and supplies essential for the provision of services, and accompanying personnel.

* Mileage: Mileage may only be billed for loaded air miles.

* Waiting Time: Waiting time which exceeds 30 minutes is reimbursable as detailed in the Waiting Time subsection of this section.