General Billing Guidelines

30 - General Billing Guidelines (Rev. 3076, Issued: 09-24-14, Effective: Upon Implementation of ICD-10 ASC X12: 01-01- 12, Implementation: ICD-10: Upon Implementation of ICD-10 ASC X12: 09-16-14) Independent ambulance suppliers may bill on the ASC X12 837 professional claim transaction or the CMS-1500 form. These claims are processed using the MCS system. Institution based ambulance providers may bill on the ASC X12 837 institutional claim transaction or Form CMS 1450. These claims are processed using the FISS system. A. Modifiers Specific to Ambulance Service Claims For ambulance service claims, institutional-based providers and suppliers must report an origin and destination modifier for each ambulance trip provided in HCPCS/Rates. Origin and destination modifiers used for ambulance services are created by combining two alpha characters. Each alpha character, with the exception of “X”, represents an origin code or a destination code. The pair of alpha codes creates one modifier. The first position alpha code equals origin; the second position alpha code equals destination. Origin and destination codes and their descriptions are listed below: D = Diagnostic or therapeutic site other than P or H when these are used as origin codes; E = Residential, domiciliary, custodial facility (other than 1819 facility); G = Hospital based ESRD facility; H = Hospital; I = Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport; J = Freestanding ESRD facility; N = Skilled nursing facility; P = Physician’s office; R = Residence; S = Scene of accident or acute event; X = Intermediate stop at physician’s office on way to hospital (destination code only) In addition, institutional-based providers must report one of the following modifiers with every HCPCS code to describe whether the service was provided under arrangement or directly: QM - Ambulance service provided under arrangement by a provider of services; or QN - Ambulance service furnished directly by a provider of services. While combinations of these items may duplicate other HCPCS modifiers, when billed with an ambulance transportation code, the reported modifiers can only indicate origin/destination. B. HCPCS Codes The following codes and definitions are effective for billing ambulance services on or after January 1, 2001. AMBULANCE HCPCS CODES AND DEFINITIONS HCPCS Code Description of HCPCS Codes A0425 BLS mileage (per mile) A0425 ALS mileage (per mile) A0426 Ambulance service, Advanced Life Support (ALS), non-emergency transport, Level 1 A0427 Ambulance service, ALS, emergency transport, Level 1 A0428 Ambulance service, Basic Life Support (BLS), non-emergency transport A0429 Ambulance service, basic life support (BLS), emergency transport A0430 Ambulance service, conventional air services, transport, one way, fixed wing (FW) A0431 Ambulance service, conventional air services, transport, one way, rotary wing (RW) A0432 Paramedic ALS intercept (PI), rural area transport furnished by a volunteer ambulance company, which is prohibited by state law from billing third party payers. A0433 Ambulance service, advanced life support, level 2 (ALS2) A0434 Ambulance service, specialty care transport (SCT) A0435 Air mileage; FW, (per statute mile) A0436 Air mileage; RW, (per statute mile) NOTE: PI, ALS2, SCT, FW, and RW assume an emergency condition and do not require an emergency designator. Refer to IOM Pub. 100-02, Medicare Benefit Policy Manual, Chapter 10 - Ambulance Service, section 30.1 - Definitions of Ambulance Services, for the definitions of levels of ambulance services under the fee schedule.