Monday, July 25, 2016

CPT code A0431 and A0430

CPT A0431

A0431 its a HCPCS code. Ambulance service, conventional air services, transport, one way (rotary wing) (RW).

The Healthcare Common Prodecure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, produts and services which may be provided to Medicare beneficiaries and to indivisuals enrolled in private health insurance programs. 

Rotary wing air ambulance is furnished when the beneficiary's medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by rotary wing air ambulance may be necessary because the beneficiary's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, e.g., heavy traffic, preclude such rapid delivery to the nearest appropriate facility. Transport by rotary wing air ambulance may also be necessary because the beneficiary is inaccessible by a land or water ambulance vehicle.


Emergency Fix Wing Air Ambulance (A0430) and Emergency Rotary Air Ambulance (A0431) 

Emergency Air Ambulance rate calculation: 

1. “Both Fixed Wing and Rotary Air Ambulance claims will paid using the following State Plan rates:

 a. Mile “1” = $586.00 Additional Miles = $13.00 

 Example: Trip was for 83 loaded miles. First (1) mile = $ 586.00 82 miles x $13.00 = $1,066.00 Total charge $1,652.00



2. For your convenience an Emergency Air Ambulance State Plan rate table is listed on page 4. The rate table is calculated up to 200 miles. DO NOT use rate table for trips over 200 miles. You would be adding in the base rate twice. Trips over 200 miles can be calculated by adding the rate of $3,173.00 for 200 miles plus $13.00 per mile over 200. 

Note: All claims must have attachments that include ambulance Pre-hospital Patient Care Report (PPCR) that establish medical necessity for emergency ground service. Beginning and ending mileage must be included on PPCR. 

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