Sunday, November 28, 2010

Modifier usage in ambulance billing and tips

Additional Modifiers for Use With Ambulance Transports

-GM Multiple patients on one ambulance trip
When more than one patient is transported in an ambulance, the Medicare allowed charge for
each beneficiary is a percentage of the allowed charge for a single beneficiary transport. The
applicable percentage is based on the total number of patients transported, including both
Medicare beneficiaries and non-Medicare patients.

Billing Tips

• Use the “GM” modifier to identify a multiple transport.
• Submit documentation to specify the particulars of a multiple transport. The
documentation must include the total number of patients transported in the vehicle at the
same time and the health insurance claim numbers for each Medicare beneficiary.
• Submit the charges applicable to the appropriate service rendered to each beneficiary and
the total mileage for the trip.
• Submit all associated Medicare claims for the multiple transports within a reasonable
number of days of submitting the first claim.
• If there is only one Medicare beneficiary in the multiple patient transports, the supplier
must document this.

-QL Patient pronounced dead after ambulance called
Time of Death Pronouncement - Ground or Water

Medicare ambulance benefits are a transport benefit If no transport of a Medicare beneficiary
occurs, then there is no Medicare covered service. In general, if the beneficiary dies before being
transported, then no Medicare payment may be made. In a situation where the beneficiary dies,
whether any payment under the Medicare ambulance benefits may be made depends on the time
at which the beneficiary is pronounced dead by an individual authorized by the State to make
such pronouncements. The chart below shows the Medicare payment determination for various
ground ambulance scenarios in which the beneficiary dies. In each case, the assumption is that
the ambulance transport would have otherwise been medically necessary.

Time of Death Pronouncement Medicare Payment Determination
  • Before dispatch No payment
  • After dispatch, before beneficiary is loaded onboard the ambulance (before or after arrival at the point of pickup).
  • After pickup, prior to or upon arrival at
    the receiving facility.

Medicare Payment Determination

  • No payment
  • The ambulance BLS base rate is paid. No mileage or rural adjustment. Use the QL modifier when submitting the claim.
  •  Medically necessary level of service furnished is allowed.

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