SyMed Tips N Tricks

Transportation Health Code Procedure Coding Tips

TRANSPORTATION SERVICES
1. VEHICLE AND CREW REQUIREMENTS: The ambulance must be designed and equipped for transporting the sick or injured and include patient care equipment, such as a stretcher, clean linens, first aid supplies, oxygen equipment and other safety and lifesaving equipment required by state or local authorities. The ambulance crew must have two members, one of which has medical training equivalent to the standard and advanced Red Cross training. The vehicle and personnel supplier must provide a statement that describes the first-aid training of the personnel and the supplier's agreement to notify Medicare of any changes that could affect coverage.

2. AIR AMBULANCE SERVICE: Air ambulance services are covered when the point of pickup is inaccessible by land vehicle; distances or other obstacles are involved in getting the patient to the nearest hospital with appropriate facilities; and, all other conditions of coverage are met.

3. AMBULANCE SERVICE CLAIMS: Reimbursement may be made for expenses incurred for ambulance services when specific conditions have been met and the appropriate medical documentation is provided.

4. MATERIALS SUPPLIED BY AMBULANCE SERVICE: Reusable devices, such as back boards, neck boards and inflatable leg and arm splints, are considered part of general ambulance services and included in the charge for the trip. A separate reasonable charge may be recognized for non-reusable items and disposable supplies, such as oxygen, gauze and dressings, that are required for patient care during the trip.

5. UNLISTED SERVICE OR PROCEDURE: A service or procedure may be provided that is not listed in this edition of HCPCS. When reporting such a service, the appropriate "unlisted procedure" code may be used to indicate the service, identifying it by "special report" as defined below. HCPCS terminology is inconsistent in defining unlisted procedures. The procedure definition may include the term(s) "unlisted", "not otherwise classified", "unspecified", "unclassified", "other" and "miscellaneous". Prior to using these codes, try to determine if a Local Level III code or CPT code is available. The "unlisted procedures" and accompanying codes for TRANSPORTATION SERVICES are as follows:

A0999 Unlisted ambulance service

6. SPECIAL REPORT: A service, material or supply that is rarely provided, unusual, variable or new may require a special report in determining medical appropriateness for reimbursement purposes. Pertinent information should include an adequate definition or description of the nature, extent, and need for the service, material or supply.

7. MODIFIERS: Listed services may be modified under certain circumstances. When appropriate, the modifying circumstance is identified by adding a modifier to the basic procedure code. CPT and HCPCS National Level II modifiers may be used with CPT and HCPCS National Level II procedure codes. One digit codes are to be used in combination. The first digit should indicate the origin; the second digit should indicate the destination.

The Level II modifiers commonly used with TRANSPORTATION codes are as follows:
-GM Multiple patients on one ambulance trip
-QM Ambulance service provided under arrangement by a provider of services
-QN Ambulance services furnished directly by a provider of services

AMBULANCE SERVICE MODIFIERS
For ambulance service, one-digit modifiers are combined to form a two-digit modifier that identifies the ambulance's place of origin with the first digit, and ambulance's destination with the second digit. They are used in items 12 and 13 on the CMS Form 1491.

One digit ambulance modifiers:
-D Diagnoistic or therapeutic site other than -P or -H when these are used as origin codes
-E Residential, domiciliary, custodial facility (other than an 1819 facility)
-H Hospital
-N Skilled nursing facility (SNF) (1819 facility)
-P Physician's office
-R Residence
-S Scene of accident or acute event
-X (Destination code only) Intermediate stop at physician's office on the way to the hospital

8. CPT CODE CROSS-REFERENCE: Unless specified otherwise, there is no equivalent CPT code for listings in this section.

Transportation Services Including Ambulance
Red: Not valid for Medicare
Blue: Carrier discretion
Purple: Non-covered by Medicare
Purple: Non-covered by Medicare

A0021 Ambulance service; outside state per mile, transport (Medicaid only)
A0080 Non-emergency transportation, per mile--vehicle provided by volunteer (individual or organization), with no vested interest
A0090 Non-emergency transportation, per mile--vehicle provided by individual (family member, self, neighbor) with vested interest
A0100 Non-emergency transportation; taxi
A0110 Non-emergency transportation and bus, intra or inter state carrier
A0120 Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems
A0130 Non-emergency transportation: wheel-chair van
A0140 Non-emergency transportation and air travel (private or commercial) intra or inter state
A0160 Non-emergency transportation: per mile--case worker or social worker
A0170 Transportation ancillary: parking fees, tolls, other
A0180 Non-emergency transportation; ancillary: lodging-recipient
A0190 ancillary: meals-recipient
A0200 ancillary: lodging-escort
A0210 ancillary: meals-escort
A0225 Ambulance service; neonatal transport, base rate, emergency transport, one way
A0382 BLS routine disposable supplies
A0384 BLS specialized service disposable supplies, defibrillation (used by ALS ambulances and BLS ambulances in jurisdictions where defibrillation is permitted in BLS ambulances)
A0392 ALS specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in BLS ambulances)
A0394 ALS specialized service disposable supplies; IV drug therapy
A0396 ALS specialized service disposable supplies; esophageal intubation
A0398 ALS routine disposable supplies
A0420 Ambulance waiting time (ALS or BLS), one-half (1/2) hour increments
A0422 Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation
A0424 Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review)
A0425 Ground mileage, per statute mile
A0426 Ambulance service, advanced life support, non-emergency transport, level 1 (ALS1)
A0427 Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)
A0428 Ambulance service, basic life support, non-emergency transport (BLS)
A0429 Ambulance service, basic life support, emergency transport (BLS-emergency)
A0430 Ambulance service, conventional air services, transport, one way (fixed wing)
A0431 Ambulance service, conventional air services, transport, one way (rotary wing)
A0432 Paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payors
A0433 Advanced life support, level 2 (ALS2)
A0434 Specialty care transport (SCT)
A0435 Fixed wing air mileage, per statute mile
A0436 Rotary wing air mileage, per statute mile
A0888 Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)
A0999 Unlisted ambulance service

(Excerpted from Health Care Procedure Coding System, National Level II, Medicare Codes, Millennium Edition 2003. Please note: Deleted codes have been excluded from this excerpt.)