A/B MAC (B) - Ambulance Services - Claims Processing

80.3.1 - A/B MAC (B) - Ambulance Services - Claims Processing (Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06) Medically necessary ambulances provided by an IHS ambulance supplier are paid based upon Chapter 15 of Pub. 100-04, Medicare Claims Processing Manual. Suppliers must report an origin and destination code for each ambulance service billed. Modifier Reporting - 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 are listed below: D - Diagnostic or Therapeutic Center other than P or H when these are used as origin codes E - Residential, Domiciliary, Custodial Facility (Other than an 1819 Facility) G - Hospital based dialysis facility (hospital or hospital related) H - Hospital I - Site of Transfer (e.g., airport or helicopter pad) between modes of ambulance transport J - Nonhospital based dialysis facility N - SNF (1819 Facility) P - Physician's Office (Includes health maintenance organization (HMO) non- hospital facility, clinic, etc.) R - Residence S - Scene of Accident or Acute Event X - (Destination code only) intermediate stop at physician's office enroute to the hospital (includes HMO non-hospital facility, clinic, etc.) All claims processing requirements in Chapter 15 of Pub. 100-04, Medicare Claims Processing Manual, shall apply to ambulance claims submitted by IHS independent ambulance suppliers. The MSN is suppressed.