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Ambulance CPT Codes, Guidelines & Modifiers (2023)

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.

CPT Codes For Ambulance Transport

There are CPT codes for 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 A0425 

Description Of CPT A0425: Ground mileage, per statute mile.

CPT A0426

Description Of 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 

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

CPT A0428

Description Of CPT A0428: Ambulance service, basic life support, non-emergency transport (BLS).

CPT A0429

Description Of CPT A0429: Ambulance service, basic life support, emergency transport (BLS-emergency).

CPT A0433 

Description Of 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

Description Of CPT A0434? Specialty Care Transport (SCT).

How Are Ambulance Modifiers Used?

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.

Ambulance Modifiers For First Position – Alpha Code Equals Origin

Modifier D: Diagnostic or therapeutic site other than P or H when these are used as origin codes.

Modifier E: Residential, domiciliary, custodial facility (other than 1819 facility)

Modifier G: Hospital based ESRD facility

Modifier H: Hospital

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

Modifier J: Freestanding ESRD facility

Modifier N Skilled nursing facility

Modifer P: Physician’s office

Modifier R: Residence

Modifier S: Scene of accident or acute event

Modifier X: Intermediate stop at physician’s office on way to hospital

Ambulance Modifiers For Second Position – Alpha Code Equals Destination

Modifier CR: Related to a catastrophe or declared disaster

Modifier GA: ABN was required and obtained

Modifier GM: Multiple patient modes of transport

Modifier GW: Hospice patient, unrelated to the hospice diagnosis

Modifier GX: ABN was optional and obtained

Modifier GY: Service that is statutorily excluded

Modifier GZ: ABN was required but not obtained

Modifier QJ: Incarcerated patient

Modifier QL: Patient pronounced dead after ambulance called

Modifier QM: Under the arrangement

Inappropriate Billing For Ambulance Transportation

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 modifier R and modifier P, modifier R for residence and modifier P for physician’s office.

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