Friday, April 15, 2016

Hospital to Hospital ambulance service CPT codes A0428, A0433 , HH modifier


HOSPITAL TO HOSPITAL TRANSFERS

Ground ambulance transfers of MO HealthNet participants from one hospital to another hospital to receive medically necessary inpatient services not available at the first facility are covered services. Hospital transfers shall be covered when the participant has
been stabilized at the first hospital but needs a higher level of care available only at a second hospital. Examples of medically necessary transfers for services not available at the first facility include, but are not limited to:

• rehabilitation

• burn unit

• ventilator assistance

• other specialized care

The hospital to hospital transfer may not be considered emergent; however, hospital to hospital transfers that meet the transfer criteria listed in section 13.13.O(1) of the MO HealthNet Ambulance provider manual qualify for coverage under the ambulance program.

The documentation in the participant’s record must support the procedure code billed. For accurate reporting purposes, the appropriate base code from the following list should be billed with the “HH” modifier.

• A0428HH – Ambulance service, BLS, non-emergency transport, hospital to hospital transfer

• A0426HH – Ambulance service, ALS 1, non-emergency transport, hospital to hospital transfer

• A0429HH – Ambulance service, BLS, emergency transport, hospital to hospital transfer

• A0427HH – Ambulance service, ALS 1, emergency transport, hospital to hospital transfer

• A0433HH – Ambulance service, ALS 2, emergency transport, hospital to hospital transfer


Transport from a hospital capable of treating the participant because the participant and/or the participant’s family or the participant's physician prefer a specific hospital is not a covered service.

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