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.
