The need for ambulatory services has seen an increase in recent years, and as a result ambulance transport claims have also risen. Payers generally cover ambulance services for patients whose medical condition is such that air transport is medically necessary. EMS Transport Coding is a unique coding set of non-physician provider services, where medical necessity is always considered. To ensure transport is medically necessary, you must consider both the patient’s condition and the method of transportation.
- Identify emergency vs nonemergency response: CMS defines an emergency response as “responding immediately at the BLS or ALS1 level of service to a 911 call or the equivalent”. An immediate response is defined as a response by the ambulance supplier that begins as quickly as possible to the call. All scheduled transports are considered non-emergency, and include routine transports to nursing home, patient homes and ESRD facilities.
- Identify the patient’s condition and the method of transport to a health facility.
- Identify the type and level of care provided by responders.
10 HCPCS Level II procedure codes for ambulance services:
Ground ambulance services
- A0425- Ground mileage, per statue mile
- A0426- Ambulance service, advanced life support, nonemergency transport, level 1(ALS1)
- A0427- Ambulance service advanced life support, emergency transport, level 1(ALS1 – emergency)
- A0428- Ambulance service, basic life support, nonemergency transport(BLS)
- A0429- Ambulance service, basic life support, emergency transport (BLS- emergency)
- A0433- Advanced life support, level 2(ALS2)
- A0434- Specialty care transport(SCT)
Air ambulance services
- A0430 – Ambulance service, conventional air services, transport, one way (fixed wing)
A0431-Ambulance service, conventional air services, transport, one way (rotary wing)
- A0888 – Non covered ambulance mileage, per mile
In addition to the HCPCS level II procedure codes a unique set of modifiers are required to identify the origin and destination.
Common modifiers for ambulance services:
GY, QL, GM, GA, GZ
Specialty modifiers for ambulance services includes origin and destination codes and their descriptions:
D, E, G, H, I, J, N, P, R, S, X