How To Use HCPCS Code A0425
HCPCS code A0425 describes ground mileage, per statute mile. This code is used to identify the cost of ground transportation services provided by an ambulance or other ground transportation vehicles. It is important for medical coders to understand the meaning and usage of this code in order to accurately bill for these services.
1. What is HCPCS A0425?
HCPCS code A0425 is used to identify the cost of ground mileage for transportation services provided by an ambulance or other ground transportation vehicles. This code specifically refers to the cost per statute mile traveled. It is important to note that this code is used for billing purposes and does not provide any specific information about the type of transportation or the medical condition of the patient.
2. Official Description
The official description of HCPCS code A0425 is “Ground mileage, per statute mile.” This description accurately reflects the purpose of this code, which is to identify the cost of ground transportation services based on the distance traveled.
3. Procedure
- When using HCPCS code A0425, the provider should accurately record the total number of statute miles traveled during the transportation service.
- The provider should then multiply the total number of statute miles by the predetermined cost per mile to calculate the total cost of the ground mileage.
- This calculated cost should be documented and included in the billing statement or claim form.
4. When to use HCPCS code A0425
HCPCS code A0425 should be used when billing for ground transportation services provided by an ambulance or other ground transportation vehicles. This code is specifically used to identify the cost of ground mileage based on the distance traveled. It is important to ensure that the transportation service meets the eligibility criteria for reimbursement and that the service is medically necessary.
5. Billing Guidelines and Documentation Requirements
When billing for services using HCPCS code A0425, healthcare providers should ensure that the following documentation requirements are met:
- Accurate documentation of the total number of statute miles traveled during the transportation service.
- Documentation of the predetermined cost per mile used to calculate the total cost of the ground mileage.
- Inclusion of the calculated cost of the ground mileage in the billing statement or claim form.
6. Historical Information and Code Maintenance
HCPCS code A0425 was added to the Healthcare Common Procedure Coding System on January 01, 2001. Since its addition, 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 code has a pricing indicator code of 52, which indicates that it is priced based on a reasonable charge methodology. The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology.
7. Medicare and Insurance Coverage
HCPCS code A0425 is payable by Medicare and other insurance providers. The pricing indicator code of 52 indicates that Medicare and other insurers will reimburse for this service based on a reasonable charge. It is important to check with individual insurance providers to determine their specific coverage policies and reimbursement rates for ground transportation services.
8. Examples
Here are five examples of when HCPCS code A0425 should be billed:
- An ambulance transports a patient from their home to a medical facility located 10 statute miles away.
- A non-emergency medical transportation service provides ground transportation for a patient to attend a doctor’s appointment located 15 statute miles away.
- A patient requires ground transportation from a hospital to a rehabilitation center located 20 statute miles away.
- An ambulance transports a patient from a nursing home to a hospital located 5 statute miles away.
- A non-emergency medical transportation service provides ground transportation for a patient to a dialysis center located 30 statute miles away.
