Monday, August 15, 2016

Some payment tips in Ambulance billing

Multi-Carrier System (MCS) Guidelines

Payment under the fee schedule for ambulance services:

• Includes a base rate payment plus a payment for mileage;

• Covers both the transport of the beneficiary to the nearest appropriate facility and all items and services associated with such transport; and

• Precludes a separate payment for items and services furnished under the ambulance benefit.

Payment for items and services is included in the fee schedule payment. Such items and services include but are not limited to oxygen, drugs, extra attendants, and EKG testing - but only when such items and services are both medically necessary and covered by Medicare under the ambulance benefit.

30.1.1 - MCS Coding Requirements for Suppliers


The ambulance fee schedule contains the following HCPCS coding logic:

• Seven categories of ground ambulance services;

• Two categories of air ambulance services;

• Payment based on the condition of the beneficiary, not on the type of vehicle used;

• Payment is determined by the point of pickup (as reported by the 5-digit ZIP Code);

• Increased payment for rural services; and

• Services and supplies included in base rate.

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