Tuesday, November 23, 2010

Ground to Air Transports and hospice patient transport billing

Ground to Air Transports

When a beneficiary is transported by ground ambulance and transferred to an air ambulance, the ground ambulance supplier may bill Medicare for the level of service provided and mileage from the point of pickup to the point of transfer to the air ambulance. The air ambulance supplier also bills for its respective services and mileage from the point of pick-up to the destination.

Gurney or Wheelchair Vans Transports
Gurney and wheelchair vans do not meet the staff, vehicle and equipment requirements to meet the Medicare coverage guidelines, therefore transportation provided in a gurney or wheelchair van is not covered by Medicare.

Note: If the beneficiary requires a denial, a claim can be submitted using HCPCS A0999 (unlisted ambulance service) and a “GY” modifier. Include in the narrative field that this service is for a gurney or wheelchair van and submitted for denial.

Hospice Patient Transports
Ambulance transports unrelated to the beneficiary’s terminal illness or on the same day as either the start or end date of hospice care is allowed. Submit the claim with the origin and destination modifiers and the GW modifier which indicates the services are unrelated. All other criteria for ambulance transports must be met. Ambulance transports related to the beneficiary’s terminal illness should be billed to Medicare Part A.

Example:
02022006 0202200641 A0428 RHGW1 1
02022006 0202200641 A0425 RHGW1 25

Hospital Discharge Transports
Patients discharged from inpatient hospital care must meet medical necessity for non-emergency transportation to the patient’s residence, skilled nursing facility, or rehabilitation hospital. Non-emergency ambulance services require a physician certification statement.

Multiple Arrivals
The general Medicare program rule is that the ambulance benefit is a transportation benefit and without a transport there is no payable service. When multiple ambulance suppliers respond, payment may be made only to the ambulance supplier that actually furnishes the transport. Ambulance suppliers that arrive on the scene but do not furnish a transport are not due payment from Medicare.

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