A/B MAC (A) - Outpatient Hospital-Based Ambulance

100.12.1.1 - A/B MAC (A) - Outpatient Hospital-Based Ambulance Services - Medicare Part B - Claims Processing (Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06) Outpatient ambulance bills from hospital-based ambulance providers are submitted with revenue code 054X (ambulance) with charges for ambulance, as well as the appropriate ambulance HCPCS codes on TOB 12X or 13X. If an outpatient encounter occurs at the same time a covered ambulance service is provided, the hospital-based ambulance providers may bill for a clinic visit (revenue code 051X) as well as the ambulance charges (revenue code 054X) and will be paid separately for each service. The MSN is suppressed.