Tuesday, December 14, 2010

Will Medicare cover excess mileage ambulance transportation?

Non Covered Mileage

Medicare only pays for medically necessary transportation to the closest facility. If a patient requests that they be transported to a more distant facility, the excess mileage will be the responsibility of the patient. A claim should be submitted to Medicare with one line for the “base rate,” one line for the “covered mileage” and one line for the “excess mileage”. The “excess mileage should be billed with HCPCS code A0888 and a “GY” modifier only.

Example: In this example the closest facility is 25 miles from the “place of pick-up.” The patient requests that they be transported to a facility 55 miles away from the “place of pick-up.” Line 2 represents the “covered” miles (25). Line 3 represents the “non-covered” miles (30) which would be the patient’s responsibility.

02022006 0202200641 A0428 RH 11
02022006 0202200641 A0425 RH 1 25
02022006 0202200641 A0888 GY 1 30


Mileage reimbursement is a Medicaid benefit when:

* A transport occurs.

* Loaded mileage is billed.

* Appropriate origin and destination modifier combinations are utilized.

Refer to the Billing & Reimbursement for Professionals or the Billing & Reimbursement for Institutional Providers chapters of this manual, as appropriate, for a list of origin and destination modifiers.

When billing for mileage greater than 100 miles, enter the origin and destination addresses in the Remarks section.


Coverage of neonatal transport includes neonatal base rate, loaded mileage, and waiting time. The cost of the transfer isolette use is included in the neonatal base rate.

The intensive care transport of critically ill neonates (i.e., newborns) to approved, designated neonatal intensive care units (regional centers) is covered, providing the designated carrier is approved by the regional center to which the provider renders service.

A hospital medical team must accompany the newborn in the ambulance for Medicaid to reimburse the services. The hospital team usually consists of a physician, nurse, and respiratory therapist. The hospital eam has primary responsibility for the newborn and the hospital is reimbursed for these services. The designated ambulance provider may bill the neonatal base rate and mileage for the transport. A return trip of a newborn from a regional center to a community hospital (after the newborn's condition is stabilized) is covered. A physician's order indicating the medical necessity of the return trip must be retained in the beneficiary's file as detailed in the Ambulance Services subsection of this chapter.

Waiting time that exceeds 30 minutes is reimbursable and must be billed as detailed in the Waiting Time subsection of this section.

No comments:

Post a Comment

Popular Posts