Friday, July 15, 2016

Basics of Air Ambulance billing

Air Ambulance Transports

A member may be transported by fixed wing (airplane) or rotary wing (helicopter) aircraft for a medically necessary air ambulance transport. The following coverage requirements apply to air transports:

• The member’s medical condition requires immediate and rapid ambulance transport.

• It cannot be furnished by BLS or ALS ground ambulance transport because one of the following pose a threat to the members’ survival or seriously endangers his or her health.

• The Point-of-pick-up (POP) is not accessible by ground vehicle (this requirement may be met in remote or sparsely populated areas). POP is the location of the member at the time he or she is placed on board the ambulance. The ZIP code of the POP or the nearest ZIP code to the POP must be reported on the claim.

• The distance to the nearest appropriate facility or the time a ground ambulance transport will take (generally more than 30 - 60 minutes).

• The instability of ground transportation.

The medical conditions that may justify air ambulance transport include, but are not limited to, the following (this list is not intended to justify air ambulance transport in all localities):

• Intracranial bleeding that requires neurosurgical intervention;

• Cardiogenic shock;

• Burns that require treatment in a burn center;

• Conditions that require treatment in a Hyperbaric Oxygen Unit;

• Multiple severe injuries; or

• Life-threatening trauma.

Air Ambulance Services

1. Base Rates

Each type of air ambulance service has a base rate. There is no conversion factor (CF) applicable to air ambulance services.

2. Geographic Adjustment Factor (GAF)

The GAF, as described above for ground ambulance services, is also used for air ambulance services. However, for air ambulance services, the applicable GPCI is applied to 50 percent of each of the base rates (fixed and rotary wing).

3. Mileage

The FS for air ambulance services provides a separate payment for mileage.

4. Adjustment for Services Furnished in Rural Areas

The payment rates for air ambulance services where the POP is in a rural area are greater than in an urban area. For air ambulance services (fixed or rotary wing), the rural adjustment is an increase of 50 percent to the unadjusted FS amount, e.g., the applicable air service base rate multiplied by the GAF plus the mileage amount or, in other words, 1.5 times both the applicable air service base rate and the total mileage amount.

The basis for a rural adjustment for air ambulance services is determined in the same manner as for ground services. That is, whether the POP is within a rural ZIP Code as described above for ground services.

Include Zip Codes on Air Ambulance Claims

Effective for claims with a date of service on or after April 19, 2015, ambulance providers must include the 5-digit zip code of the point-of-pick-up. This is required for both emergent and non-emergent air ambulance services. This claims filing requirement also applies for Medicare crossover claims when Medicare’s benefits do not cover the claim.

• For claims filed electronically through a clearinghouse, include the pick-up location zip code in the 2310E Ambulance Pick-up Location Loop of the ASC X12N Health Care Claim (837).

• For hardcopy and iLinkBLUE-filed claims, include the pick-up location zip code on line 23 of the CMS- 1500 claim form.

Claims that do not include the point-of-pick-up zip code on the claim will be denied for insufficient information.

Where to file air ambulance claims for dates of service on and after April 19, 2015:

If the pick-up location zip code is in Louisiana, the claim should be filed directly to Blue Cross and Blue Shield of Louisiana.

If the pick-up location zip code is outside of Louisiana, the claim should be filed to the local Blue Plan that covers the area of pick-up.

If the pick-up location is outside of the United States, Puerto Rico or U.S. Virgin Islands, the claim must be filed to the BlueCard Worldwide Program (

No comments:

Post a Comment

Popular Posts