Ambulance billing CPT code full list

Codes Specific to Air Ambulance


HCPCS Procedure Code Description

A0430   Ambulance service, conventional air service, transport, one way (fixed wing)

A0431 Ambulance service, conventional air services, transport, one way (rotary wing)

A0435  Fixed wing air mileage, per statute mile

A0436 Rotary wing air mileage, per statute mile

S9960  Ambulance service, conventional air services, nonemergency transport, one way (fixed wing)

S9961  Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)

T2007  Transportation waiting time, air ambulance and non-emergency vehicle, one-half (1/2) hour increments


Ground/Other Ambulance Codes


HCPCS Procedure Code   Description

A0225  Ambulance service, neonatal transport, base rate, emergency transport, one way

A0380   BLS mileage (per mile)

A0382  BLS routine disposable supplies

A0384  BLS specialized service disposable supplies; defibrillation (used by ALS ambulances and BLS ambulances in jurisdictions where defibrillation is permitted in BLS ambulances)

A0390  ALS miles (per mile)

A0392  ALS specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed by BLS ambulances)

A0394 ALS specialized service disposable supplies; IV drug

A0396 ALS specialized service disposable supplies; esophageal intubation

A0398 ALS routine disposable supplies

A0420 Ambulance waiting time (ALS or BLS), one-half (1/2) hour increments

A0422 Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation

A0424  Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review)

A0425 Ground mileage, per statuTe mile

A0426 Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1)

A0427 Ambulance service, advanced life support, emergency transport, level 1 (ALS 1-emergency)

A0428 Ambulance service, basic life support, non-emergency transport (BLS)

A0429 Ambulance service, basic life support, emergency transport (BLS-emergency)

A0432 Paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers

A0433 Advanced life support, level 2 (ALS 2)

A0434 Specialty care transport (SCT)

A0998 Ambulance response and treatment, no transport

A0999 Unlisted ambulance service

S0207 Paramedic intercept, non-hospital based ALS, non-transport

S0208  Paramedic intercept, hospital based ALS, non-transport


Group 1 Codes:

A0425 Ground mileage
A0426 Als 1
A0427 Als1-emergency
A0428 Bls
A0429 Bls-emergency
A0430 Fixed wing air transport
A0431 Rotary wing air transport
A0432 Pi volunteer ambulance co
A0433 Als 2
A0434 Specialty care transport
A0435 Fixed wing air mileage
A0436 Rotary wing air mileage
A0888 Noncovered ambulance mileage
A0998 Ambulance response/treatment



Emergency - Ambulance Services (Ground)

Medicare will cover emergency ambulance services when the services are medically necessary, meet the destination limits of closest appropriate facilities, and are provided by an ambulance service that is licensed by the state.

Medical Necessity

Medical necessity is established if the patient's condition is an emergency and the patient is unable to go to the hospital by other means.


An emergency means services provided after the sudden onset of a medical condition, manifesting itself by acute signs or symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in the following: placing the patient's health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.


The definition of “911 call” is described in the Utilization Guidelines section.

Destination

Covered destinations for emergency ambulance services include:


Acute care hospitals


Physician's office only if, during an emergency transportation to a hospital when, because of dire need for professional attention, the ambulance stops at a physician's office en route and immediately thereafter continues to the hospital. In such cases, the patient will be deemed not to have been transported to the physician's office and payment may be made for the entire trip.


Transfer site (airport/helicopter). As a general rule, only local transportation by an ambulance is covered.


In order for ambulance services to be a covered benefit the transport must be to the nearest institution with appropriate facilities for the treatment of the illness or injury involved. The term "appropriate facilities" means that the institution is generally equipped to provide the needed hospital care for the illness or injury involved. It is the institution, its equipment, its personnel and its capability to provide the services necessary to support the required medical care that determine whether it has appropriate facilities.

The fact that a more distant institution is better equipped, either qualitatively or quantitatively, to care for the patient does not warrant a finding that a closer institution does not have "appropriate facilities." However, a legal impediment barring a patient's admission would permit a finding that the institution did not have "appropriate facilities". For example, the nearest appropriate specialty hospital may be in another state and that state's law precludes admission of nonresidents.

In the case of ambulance services to a facility other than the closest appropriate facility, only those miles to the closest facility are eligible for coverage.

Certification 

A Physician Certification Statement is not required for emergency transports.
Non Emergency Ambulance Service (Ground)

For non-emergency ambulance transportation, transportation by ambulance is appropriate if the beneficiary is bed-confined and it is documented that the beneficiary's medical condition is such that other methods of transportation are contraindicated, or if his or her medical condition, regardless of bed-confinement, is such that transportation by ambulance is medically required.

Medicare coverage for non-emergency ambulance services is available:

Only when transportation by any other means is contraindicated by the medical condition of the patient;


Only to specific destinations; and


Only when certified as medically necessary by a physician directly responsible for the patient's care, with limited exceptions. (See ‘ Certification’ section below for special rules for scheduled, repetitive ambulance services and ambulance services that are either unscheduled or scheduled on a non-repetitive basis).


NOTE: All three of the above criteria must be met.

Medical Necessity

Ambulance transport in non-emergency situations must meet medical necessity guidelines.

Medical necessity is established for non-emergency ambulance services when the patient's condition is such that the use of any other method of transportation (such as: taxi, private car, wheelchair van, or other type of vehicle) is contraindicated. If the condition contraindicating other means of transportation is "bed confined", the patient must meet the following condition of "bed confined." The inability to:


Get up from bed without assistance;AND

Ambulate; AND

Sit in a chair (including a wheelchair).

NOTE: All three components must be met in order for the patient to be considered "bed-confined." It does not include a patient who is restricted to bed rest on a physician's instructions due to a short-term illness. Examples of situations in which patients are bed confined and cannot be moved by wheelchair, but must be moved by stretcher include:

Contractures creating non-ambulatory status and patient cannot sit.

Severe generalized weakness.

Severe vertigo causing inability to remain upright.

Immobility of lower extremities (patient in spica cast, fixed hip joints, or lower extremity paralysis) and unable to be moved by wheelchair.

If some means of transportation other than an ambulance (such as: private car, wheel chair van, etc.) could be utilized without endangering the individual's health, whether or not such other transportation is actually available, no payment may be made for ambulance service.


If transportation is for the purpose of receiving an excluded service (such as a routine dental examination) then the transportation is also excluded even if the patient could only have gone by ambulance.


If transportation is for the purpose of receiving a service that could have been safely and effectively provided in the point of origin (residence, Skilled Nursing Facility (SNF), hospital, etc.) then the transport is not covered even if the patient could only have gone by ambulance.


Ambulance transportation for services excluded from SNF consolidated billing must meet the criteria as reasonable and necessary (i.e. other means contraindicated).

Destination

Covered destinations for "non-emergency" transports include:

Acute care hospitals (Appropriate facility)


Inpatient Rehabilitation Facilities (IRFs)

Long-Term Acute Care (LTAC) Hospitals

SNF


Dialysis Facilities- ambulance services furnished to a maintenance dialysis patient should show that the patient's condition requires ambulance services


From a SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a resident, including the return trip


The patient's residence (only if this is a return from an "appropriate facility")


In order for ambulance services to be a covered benefit the transport must be to the nearest institution with appropriate facilities for the treatment of the illness or injury involved. The term "appropriate facilities" means that the institution is generally equipped to provide the needed hospital or skilled nursing care for the illness or injury involved. It is the institution, its equipment, its personnel and its capability to provide the services necessary to support the required medical care that determine whether it has appropriate facilities.

The fact that a more distant institution is better equipped, either qualitatively or quantitatively, to care for the patient does not warrant a finding that a closer institution does not have "appropriate facilities." However, a legal impediment barring a patient's admission would permit a finding that the institution did not have "appropriate facilities." For example, the nearest appropriate specialty hospital may be in another State and that State's law precludes admission of nonresidents
In the case of ambulance services that are to a facility other than the closest appropriate facility, only those miles to the closest facility are eligible for coverage.

NOTE: If the transport is for the purpose of receiving a non-covered service, then the transport is also non-covered, even if the destination is an "appropriate facility."

Certification

Providers/suppliers of ambulance transportation must obtain a written certification from the physician for all scheduled transports certifying the medical necessity of the ambulance services. Requirements for non-emergency ambulance transportation include:


Scheduled, repetitive ambulance services:


The physician's order must be dated no earlier than 60 days in advance of the transport for repetitive patients whose transportation is scheduled in advance.

Unscheduled or scheduled on a non-repetitive basis:


For residents in facilities who are under the direct care of a physician, written certification of medical necessity can be obtained within 48 hours after the transport.

If the ambulance provider/supplier is unable to obtain a signed physician certification statement from the beneficiary’s attending physician, a signed certification statement must be obtained from either the physician assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS), a registered nurse (RN), or discharge planner, who has personal knowledge of the beneficiary’s condition at the time the ambulance transport is ordered or the service is furnished. This individual must be employed by the beneficiary’s attending physician or by the hospital or facility where the beneficiary is being treated and from which the beneficiary is transported. Medicare regulations for PAs, NPs, and CNSs apply and all applicable State licensure laws apply.

The ambulance provider/supplier is responsible for obtaining the signed certification with the appropriate signatures as expeditiously as possible, and must obtain the signed order before billing for the service.

If the ambulance provider/supplier is unable to obtain the written certification with appropriate signatures within 21 days after delivery of service the provider/supplier may bill only if there is documentation of good faith effort to obtain the order and certification. Acceptable documentation includes a signed return receipt from the U.S. Postal Service or other similar service that evidences that the ambulance provider/supplier attempted to obtain the required signature.

For a beneficiary residing at home or in a facility who is not under the direct care of a physician, a physician certification is not required.


NOTE: It is important to note that the presence of the signed physician certification statement does not necessarily demonstrate that the transport was medically necessary. The ambulance provider/supplier must meet all coverage criteria in order for payment to be made.
Emergency Air Ambulance Transportation

Medically appropriate air ambulance transportation either by means of a helicopter or fixed wing aircraft is a covered service regardless of the state or region in which it is rendered only if the beneficiary's medical condition required immediate and rapid ambulance transportation that could not have been provided by land ambulance, or either:


The point of pick-up is inaccessible by land vehicle (this condition could be met in Hawaii, Alaska, and in other remote or sparsely populated areas of the continental United States), or
Great distances or other obstacles (for example, heavy traffic) are involved in getting the patient to the nearest hospital with appropriate facilities as described in this policy.

Medicare payment determination for various air ambulance scenarios in which the flight is aborted due to bad weather, or other circumstances beyond the pilot’s control is as follows:


If the flight is aborted anytime before the beneficiary is loaded on board (i.e. prior to or after take-off to point-of-pickup), then there is no provision for Medicare payment.

If the flight is aborted after the beneficiary is loaded onboard from transport, the Medicare payment is for the appropriate air base rate, mileage, and rural adjustment.

Medical Necessity

Medical appropriateness is only established when the beneficiary's condition is such that the time needed to transport a beneficiary by land, or the instability of transportation by land, poses a threat to the beneficiary's survival or seriously endangers the beneficiary's health. These conditions may include, but are not limited to:

Intracranial bleeding - requiring neurosurgical intervention;


Cardiogenic shock;


Burns requiring treatment in a Burn Center;


Conditions such as carbon monoxide poisoning requiring treatment in a Hyperbaric Oxygen Unit;


Multiple severe injuries;


Life-threatening trauma.

Destination

Air ambulance transport is covered for transfer of a patient between hospitals when:

The point from which the beneficiary is transported to the nearest hospital with appropriate facilities is inaccessible by land vehicle, or great distances, or other obstacles (e.g. heavy traffic), AND


The beneficiary’s medical condition is not appropriate for transport by either BLS or ALS ground ambulance.

Certification

Certification requirements for air ambulance are based on the level of service provided (i.e. emergency and non-emergency). For the specific requirements, please see the corresponding ground transport physician certification requirements (i.e. emergency and non-emergency).
Limitations

Ambulance Services are not covered in the following circumstances:

Failure to obtain appropriate physician order and/or certification (as defined and required in this LCD) prior to billing for services.


When other means of transportation are not contraindicated. Coverage will not be allowed if the only documentation of medical necessity is "non-ambulatory".


Transfer from a hospital or SNF, which has appropriate facilities, to a second hospital or SNF.


The patient is not transported. (See exception re: patient death).


The patient is ambulatory and there is no emergency.


Transportation is to a non-covered destination.


Transportation is for purposes of obtaining a non-covered service.


Air Ambulance services are not covered for transport to a facility that is not an acute care hospital, such as a nursing facility, physician's office or a beneficiary's home.


If a determination is made that transport by ambulance was necessary, but land ambulance service would have sufficed, payment for the air ambulance service is based on the amount payable for land transport, if less costly.


If the transport was medically appropriate but the beneficiary could have been treated at a nearer hospital than the one to which he or she was transported, the transport payment is limited to the rate for the distance from the point of pickup to that nearer hospital.


Transport was to a funeral home.


The ambulance was used solely because other means of transportation were unavailable.


The individual merely needed assistance in getting from his room or home to a vehicle.

1 comment:

  1. It is useful to think about the design and location of the CBD stations, as these stations will have the greatest influence on SRT capacity and effectiveness. Global Freight Forwarder

    ReplyDelete

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