How To Use HCPCS Code A0160

HCPCS code A0160 describes non-emergency transportation services provided by a case worker or social worker. This code is used to identify the transportation of patients who require assistance in reaching their healthcare appointments or facilities but do not have an urgent medical condition. In this article, we will explore the details of HCPCS code A0160, 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 A0160?

HCPCS code A0160 is used to identify non-emergency transportation services provided by a case worker or social worker. This code is specifically used for patients who require assistance in reaching their healthcare appointments or facilities but do not have an urgent medical condition. It is important to note that this code is not applicable for emergency situations where immediate medical attention is required.

2. Official Description

The official description of HCPCS code A0160 is “Noner transport case worker.” The short description is “Non-emergency transportation: per mile – case worker or social worker.”

3. Procedure

1. The case worker or social worker assesses the transportation needs of the patient.
2. They arrange for non-emergency transportation services.
3. The transportation service provider transports the patient to their healthcare appointment or facility.
4. The case worker or social worker ensures the safe arrival of the patient.

4. When to use HCPCS code A0160

HCPCS code A0160 should be used when a patient requires non-emergency transportation services provided by a case worker or social worker. This code is applicable for patients who need assistance in reaching their healthcare appointments or facilities but do not have an urgent medical condition.

5. Billing Guidelines and Documentation Requirements

Healthcare providers need to document the need for non-emergency transportation services and the involvement of a case worker or social worker. The documentation should include the patient’s medical condition, the reason for non-emergency transportation, and the role of the case worker or social worker in arranging and overseeing the transportation services. When billing for this service, providers should use HCPCS code A0160 and ensure that the documentation supports the medical necessity of the transportation services.

6. Historical Information and Code Maintenance

HCPCS code A0160 was added to the Healthcare Common Procedure Coding System on January 01, 1984. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. The code has an effective date of January 01, 1995. It is important to stay updated with any changes or revisions to the code, as well as any updates in the documentation requirements.

7. Medicare and Insurance Coverage

HCPCS code A0160 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 means the service is not separately priced by Part B. This could be due to the service not being 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 A0160 should be billed:

1. A case worker arranges non-emergency transportation for a patient with limited mobility to attend a physical therapy session.
2. A social worker coordinates transportation for a patient with a chronic illness to visit a specialist for a consultation.
3. A case worker arranges transportation for a patient with a mental health condition to attend therapy sessions.
4. A social worker coordinates transportation for a patient undergoing regular dialysis treatments.
5. A case worker arranges transportation for a patient with a disability to attend a medical appointment.