How To Use HCPCS Code A0021

HCPCS code A0021 describes ambulance services provided outside of the state on a per mile basis, specifically for Medicaid beneficiaries. This code is used to identify the transportation of patients from one state to another for medical purposes. In this article, we will explore the details of HCPCS code A0021, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A0021?

HCPCS code A0021 is used to identify ambulance services provided outside of the state on a per mile basis for Medicaid beneficiaries. It is important to note that this code is specific to Medicaid and may not be applicable for other insurance providers. Ambulance services are crucial for transporting patients who require medical attention and cannot be safely transported by other means.

2. Official Description

The official description of HCPCS code A0021 is “Ambulance service, outside state per mile, transport (medicaid only)”. The short description is “Outside state ambulance serv”. This code specifically refers to the transportation of patients outside of the state on a per mile basis, and it is only applicable for Medicaid beneficiaries.

3. Procedure

1. Ensure that the patient is eligible for Medicaid coverage and meets the criteria for ambulance transportation.
2. Coordinate with the appropriate ambulance service provider to arrange for the transportation.
3. Document the starting point and destination of the transportation, as well as the distance in miles.
4. Submit the claim using HCPCS code A0021, along with any other necessary documentation.

4. When to use HCPCS code A0021

HCPCS code A0021 should be used when providing ambulance services outside of the state on a per mile basis to Medicaid beneficiaries. It is important to ensure that the patient meets the eligibility criteria for Medicaid coverage and that the transportation is medically necessary. This code should not be used for emergency situations where immediate medical attention is required.

5. Billing Guidelines and Documentation Requirements

When billing for ambulance services using HCPCS code A0021, healthcare providers need to ensure that the following documentation is included:

• Proof of Medicaid eligibility for the patient
• Documentation of medical necessity for the transportation
• Starting point and destination of the transportation
• Distance in miles for the transportation

Providers should also follow the billing guidelines set forth by Medicaid and any other applicable insurance providers to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A0021 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of September 10, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This suggests that the code has remained unchanged since its addition to the system.

7. Medicare and Insurance Coverage

HCPCS code A0021 is not payable by Medicare, as indicated by the coverage code I, which means it is not payable by Medicare. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service is either not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code A0021 should be billed:

1. A Medicaid beneficiary requires transportation from a hospital in one state to a specialized medical facility in another state for a specific medical procedure.
2. A patient with Medicaid coverage needs to be transported from their home state to a neighboring state for a consultation with a specialist.
3. A Medicaid beneficiary residing in a border town needs transportation to a hospital located across the state border for emergency medical treatment.
4. A patient with Medicaid coverage requires transportation from a long-term care facility in one state to a different facility in another state for specialized care.
5. A Medicaid beneficiary needs transportation from their home state to a different state for a clinical trial or research study.