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Ambulance Procedure Codes

Medicare covers ambulance services, including fixed wing and rotary wing ambulance services, only if they are furnished to a beneficiary whose medical condition is such that other means of transportation are contraindicated. The beneficiary's condition must require the ambulance transportation itself and the level of service provided in order for the billed service to be considered medically necessary.

Ambulance services are divided into different levels of ground (including water) and air ambulance services based on the medically necessary treatment during transport. The following Health Care Procedure Coding System (HCPCS) procedure codes are to be billed to Medicare to describe the type and level of services rendered by the ambulance crew.

Based on the documented services provided, the ambulance supplier must select and submit the procedure code that describes the provided level of service. The correct origin and destination modifier combination must be submitted next to the procedure code. For more information regarding valid ambulance modifiers please see Ambulance Modifiers.

HCPCS Procedure Codes

A0425 Ground mileage, per statute mile
A0426 Ambulance service, advanced life support, non-emergency transport, level 1 (ALS1)
A0427 Ambulance service, advanced life support, emergency transport, level 1 (ALS1- Emergency)
A0428 Ambulance service, basic life support, non-emergency transport (BLS)
A0429 Ambulance service, basic life support, emergency transport (BLS-Emergency)
A0430 Ambulance service, conventional air services, transport, one way (fixed wing) (FW)
A0431 Ambulance service, conventional air services, transport, one way (rotary wing) (RW)
A0433 Advanced life support, level 2 (ALS2)
A0434 Specialty care transport (SCT)
A0435 Fixed wing air mileage, per statute mile
A0436 Rotary wing air mileage, per statute mile
A0888 Non-covered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)

Categories of Ambulance Services

Ground Ambulance Services

There are seven categories of ground ambulance services and two categories of air ambulance services under the fee schedule. ("Ground" refers to both land and water transportation.)

The level of service is determined based on the patient condition, not the vehicle used.

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

Basic Life Support (BLS) means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services.

The ambulance must be staffed by an individual who is qualified in accordance with State and local laws as an emergency medical technician-basic (EMT-Basic). These laws may vary from State to State. For example, only in some states is an EMT-Basic permitted to operate limited equipment on board the vehicle, assist more qualified personnel in performing assessments and interventions and establish a peripheral intravenous (IV) line.

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

The Basic Life Support - Emergency category is the provision of BLS services, as specified above, in the context of an emergency response.

Emergency response means responding immediately at the BLS or ALS1 level of services to a 911 call or the equivalent. An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call. The nature of the call at the time of dispatch is the determining factor. Regardless of the medium by which the call is made, the call is of an emergent nature when, based on the information available to the dispatcher at the time of the call, it is reasonable for the dispatcher to issue an emergency dispatch in light of accepted, standard dispatch protocol.

A0426 - Ambulance service, advanced life support, non-emergency transport, level 1 (ALS1)

Advanced life support, level 1, (ALS1) means transportation by ground ambulance, medically necessary supplies and services and an ALS assessment by ALS personnel or the provision of at least one ALS intervention.

Advanced life support assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.

Advanced life support intervention means a procedure that is, in accordance with State and local laws, beyond the scope of authority on an emergency medical technician-basic (EMT-Basic). An unsuccessful attempt to perform an ALS Intervention may qualify the transport for billing at the appropriate ALS level provided that the intervention would have been reasonable and necessary had it been successful.

Advanced life support personnel means an individual trained to the level of the emergency medical technician - intermediate (EMT-Intermediate) or paramedic.

The EMT-Intermediate is defined as an individual who is qualified, in accordance with State and local laws, as an EMT-Basic and who is also qualified in accordance with State and local laws to perform essential advanced techniques and to administer a limited number of medications.

The EMT-Paramedic is defined as possessing the qualifications of the EMT Intermediate and also, in accordance with State and local laws, as having enhanced skills that includes being able to administer additional interventions band medications.

A0427 -Ambulance service, advanced life support, emergency transport, level 1 (ALS1- emergency)

The Advanced Life Support, Level 1 - Emergency response category is defined as the provision of ALS1 services as specified above, in the context of an emergency response.

Emergency response means responding immediately at the BLS or ALS1 level of service to a 911 call or the equivalent in areas without a 911 call system. An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call.

(ALS- 2 and SCT emergency is assumed.)

A0433 - Advanced Life Support, Level 2 (ALS2)

The Advanced Life Support, Level 2 category is:

  1. Three or more different administrations of medications by intravenous push/bolus or by continuous infusion excluding crystalloid, hypotonic, isotonic, and hypertonic solutions (Dextrose, Normal Saline, Ringer's Lactate), or
  2. Ground transportation, medically necessary supplies and services, and the provision of at least one of the following ALS procedures:
    Manual defibrillation/cardioversion Endotracheal intubation (The monitoring and maintenance of an endotracheal tube that was previously inserted prior to the transport also qualifies as an ALS2 procedure.)
    Central venous line
    Cardiac pacing
    Chest decompression
    Surgical airway or
    Intraosseous line

A0434 - Specialty Care Transport (SCT)

SCT is an inter-facility transportation of a critically injured or ill beneficiary by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT paramedic.

SCT is necessary when a beneficiary's condition requires ongoing care that must be provided by one or more health professionals in an appropriate specialty area (for example emergency, or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training). This person does not have to be an employee of the ambulance company.

A0425 - Ground Mileage, per statute mile
Air Ambulance Services

There are two categories of air ambulance services: fixed wing (airplane) and rotary wing (helicopter) aircraft. The higher operational costs of the two types of aircraft are recognized with two distinct payment amounts for air ambulance mileage. The air ambulance mileage rate is calculated per actual loaded (patient onboard) miles flown and is expressed in statute miles (not nautical miles).

A0430 - Ambulance service, conventional air services, transport, one way
(Fixed Wing Air Ambulance FW)

Fixed 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 fixed 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 fixed wing air ambulance may also be necessary because the beneficiary is inaccessible by a land or water ambulance vehicle.

A0431 - Ambulance service, conventional air service, transport, one way
(Rotary Wing Air Ambulance RW)

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.

A0435 - Fixed wing air mileage, per statute mile
A0436 - Rotary wing air mileage, per statute mile
A0888 - Non-covered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)

Emergency VS Non-Emergency

CMS defines an emergency response as "responding immediately at the BLS or ALS1 level of service to a 911 call or the equivalent. An immediate response is one is which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call.

Emergency response is based on the information received during the call and how the supplier is responding. It is based on the internal supplier protocols. The call does not have to come through a 911 system even if the area has a 911-call system.

All scheduled transports will be considered non-emergency. Transports to nursing homes, patient homes and ESRD facilities will be considered non-emergency.

Providers should verify that emergency and non-emergency codes are used correctly.

This will facilitate accurate and timely processing of claims.

Non-Covered Services

Effective January 1, 2012, CMS allows ambulance providers to bill procedure codes for non-covered ambulance services. This does not include supplies associated with a covered ambulance transport. CMS Internet Only Manual Publication 100-04, Chapter 15, Section 30.1 indicates those supplies are included in the base rate. If the supplies are associated with a non-covered service, then they are billable to Medicare with Modifier GY. Procedure codes A0021 - A0424 and A0998 are billable procedure codes and must include the Modifier GY; however, they are not payable by Medicare.

References:

For more information regarding definitions and applications of items used throughout the ambulance chapter, see CMS Internet Only Manual, 100-4, Medicare Claims Processing Manual, Chapter 15, 10.3

For definitions of the levels of service, refer to CMS Internet Only Manual, 100-2, Medicare Benefit Policy Manual, Chapter 30, 30.1.1 and 30.1.2

For more information on Non-Covered Services and how to bill them view Instructions to Accept and Process All Ambulance Transportation Healthcare Common Procedure Coding System (HCPCS) Codes (MM 7489)
or Change Request (CR) 7489.

For more information regarding coverage and claim submission for ambulance services see Ambulance Computer Based Training (CBT) Ambulance Suppliers: Back to the Basics on the On Demand Training page.

Page Last Updated: Wednesday, 26-Nov-2014 12:30:30 CST