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Ambulance coding guidelines and billing, CPT codes and modifiers

ambulance coding guidelines

Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would endanger the patient’s health.

Ambulance coding guidelines | Codes used to report Ambulance services

There are seven categories of ground ambulance services that refers to both land and water transportation and selection of codes would be based on the services rendered and patient’s condition at the time of transport.

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

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

CPT A0426 Ambulance service, advanced life support, non-emergency transport, level (ALS1) that includes medically necessary supplies and services and provision of at least one ALS intervention but not limited to Administration of IV fluids (except blood or blood products), Peripheral venous puncture, Blood drawing, Monitoring IV solutions during transport that contain potassium, Administration of approved medications, IV, Sub Q, sublingual, nebulizer inhalation, IM (limited to deltoid and thigh sites only)

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

CPT A0433 Advanced life support, level 2 (ALS2) includes medically necessary supplies and services, and at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion, excluding crystalloid hypotonic, isotonic and hypertonic solutions (dextrose, normal saline, or Ringer’s lactate), or transportation, medically necessary supplies and services, and the provision of at least one of the following procedures: Manual defibrillation/cardioversion, Endotracheal intubation, Central venous line, Cardiac pacing, Chest decompression, Surgical airway, Intraosseous line.

CPT A0434 Specialty Care Transport (SCT)

CPT A0425 Ground mileage, per statute mile

Modifiers for Ambulance billingAmbulance billing codes

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. The first position alpha code equals origin; the second position alpha code equals destination.

Diagnostic or therapeutic site other than P or H when these are used as origin codes

Residential, domiciliary, custodial facility (other than 1819 facility)

Hospital based ESRD facility

Hospital

Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport

Freestanding ESRD facility

Skilled nursing facility

Physician’s office

Residence

Scene of accident or acute event

Intermediate stop at physician’s office on way to hospital

Please note:

It is considered as inappropriate billing if an ambulance provider uses a modifier that does not describe the origin and destination. For example, if a patient is taken from his residence to the physician’s office then this transfer should be billed with modifiers R and P, R for residence and P for physician’s office.

For services rendered prior to January 1, 2011 the mileage should be reported as whole numbers but for the services rendered on or after January 1, 2011 the mileage should be reported as fractional units.

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