ambulance trip cpt code

Ambulance CPT Codes, Guidelines & Modifiers (2023)

Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would endanger the patient’s health.

CPT Codes For Ambulance Transport

There are CPT codes for ground ambulance services that refers to both land and water transportation and selection of codes would be based on the services rendered and patient’s condition at the time of transport.

Description Of CPT A0425 : Ground mileage, per statute mile.

Description Of CPT A0426 : Ambulance service, advanced life support, non-emergency transport, level (ALS1) that includes medically necessary supplies and services and provision of at least one ALS intervention but not limited to Administration of IV fluids (except blood or blood products), Peripheral venous puncture, Blood drawing, Monitoring IV solutions during transport that contain potassium, Administration of approved medications, IV, Sub Q, sublingual, nebulizer inhalation, IM (limited to deltoid and thigh sites only).

Description Of CPT A0427 : Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency).

Description Of CPT A0428 : Ambulance service, basic life support, non-emergency transport (BLS).

Description Of CPT A0429 : Ambulance service, basic life support, emergency transport (BLS-emergency).

Description Of CPT A0433 ? Advanced life support, level 2 (ALS2) includes medically necessary supplies and services, and at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion, excluding crystalloid hypotonic, isotonic and hypertonic solutions (dextrose, normal saline, or Ringer’s lactate), or transportation, medically necessary supplies and services, and the provision of at least one of the following procedures: Manual defibrillation/cardioversion, Endotracheal intubation , Central venous line, Cardiac pacing, Chest decompression, Surgical airway, Intraosseous line.

Description Of CPT A0434 ? Specialty Care Transport (SCT).

How Are Ambulance Modifiers Used ?

For ambulance service claims, institutional-based providers and suppliers must report an origin and destination modifier for each ambulance trip provided in HCPCS/Rates.

Origin and destination modifiers used for ambulance services are created by combining two alpha characters.

Ambulance Modifiers For First Position – Alpha Code Equals Origin

Modifier D:  Diagnostic or therapeutic site other than P or H when these are used as origin codes.

Modifier E:  Residential, domiciliary, custodial facility (other than 1819 facility)

Modifier G: Hospital based ESRD facility

Modifier H:  Hospital

Modifier I: Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport

Modifier J:  Freestanding ESRD facility

Modifier N  Skilled nursing facility

Modifer P:  Physician’s office

Modifier R: Residence

Modifier S:  Scene of accident or acute event

Modifier X: Intermediate stop at physician’s office on way to hospital

Ambulance Modifiers For Second Position – Alpha Code Equals Destination

Modifier CR: Related to a catastrophe or declared disaster

Modifier GA : ABN was required and obtained

Modifier GM : Multiple patient modes of transport

Modifier GW : Hospice patient, unrelated to the hospice diagnosis

Modifier GX : ABN was optional and obtained

Modifier GY : Service that is statutorily excluded

Modifier GZ : ABN was required but not obtained

Modifier QJ : Incarcerated patient

Modifier QL : Patient pronounced dead after ambulance called

Modifier QM : Under the arrangement

Inappropriate Billing For Ambulance Transportation

It is considered as inappropriate billing if an ambulance provider uses a modifier that does not describe the origin and destination.

For example, if a patient is taken from his residence to the physician’s office then this transfer should be billed with modifier R and modifier P, modifier R for residence and modifier P for physician’s office.

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Ambulance Transportation CPT Codes and Modifiers

Ambulance transportation services that are covered in Medicare part B covers ground ambulance transportation when a patient needs to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services while the transportation in another vehicle could be hazardous for patient’s health. However, ambulance transportation has certain risks.

The risk involved in Ambulance transportation

Emergency Medical Services (EMS) is included in Ambulance and patient transport services while private ambulance services which supply various services such as emergency prehospital care, basic medical support and roadside transport to hospitals for patients experiencing medical emergencies, However, ambulance transportation has certain risk such as high speeds and the use of lights, sirens, which potentially results in ambulance crashes that may injure or cause the death of patients, providers, pedestrians.

To make ambulance transport safer various guidelines are currently being developed

• Drive cautiously at safe speeds, observing traffic laws,
• Encourage the utilization of the Department of Transportation National Highway Traffic Safety Administration Emergency Vehicle Operating Course (EVOC), and National Standard Curriculum

An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call and emergency ambulance services are provided after the sudden medical condition.

Role of Emergency Medical Technician for prehospital ambulance transport

Generally, hospitalists directly interact with ambulance transport teams who have picked patients up from their homes or other nonmedical settings and brought them to the hospital. But an emergency medical technician (EMT) may be the primary provider on prehospital ambulance transport.

EMTs are typically undergone approximately 40 to 100 hours of medical training in which a small portion may be pediatric. Moreover, These EMTs have limited assessment and interventional capabilities, also local statutes govern what procedures EMTs can perform during transport.

While a higher level of EMS transport involves paramedics who have approximately 1 year of medical training and usually at least 16 hours and a limited practicum involving pediatrics.

Reimbursement for Ambulance services

All insurance companies including Medicare and Medicaid pay for ambulance and emergency services. However, the unique and detailed modifiers and the various modes of transport include ground, water, fixed-wing, and rotary-wing make coding and billing for ambulance transportation services complicated.

Healthcare providers should record correct clinical documentation during the case for reimbursement. Moreover, coding and billing are strictly based on this recorded documentation, so the documentation must be complete and accurate.

CPT codes that are used in ambulance transportation billing are relatively low but we can witness various unique modifiers and the complicating factors which have a significant impact on reimbursement.

The CPT codes for ambulance Transportation:

There are seven categories of ground ambulance services which include both land and water transportation. The selection of codes is based on the patient’s condition at the time of transport as well as services rendered.

A0425 Ground mileage, per statute mile

A0426 Ambulance service, (ALS), non-emergency transport (Level 1)

A0427 – ALS (Level 1), Emergency

A0428 – Basic Life Support, Non-Emergency

A0429 – Basic Life Support, Emergency

A0433 – Advanced life support, level 2 (ALS2)

A0434- Specialty Care Transport (SCT)

Now, let’s look at some modifiers as these modifiers are two characters that represent origin and destination, and they are designed to show first the origin and second the destination:

Some of the modifiers for Ambulance Transportation

D – Diagnostic or therapeutic site excluded P or H when these are used as origin codes

E- Residential, domiciliary, custodial facility excluded 1819 facility

G – Hospital-based ESRD facility

H – Hospital

I – Site of transfer between modes

J – Freestanding ESRD facility

N Skilled nursing facility

P Physician’s office

R Residence

S Scene of accident or such acute event

X Intermediate stop at physician’s office along the way to the hospital

Some second modifiers for Ambulance Transportation

Now let’s look at some second modifiers to be included after the origin and destination modifier. These can include but are not limited to:

CR – Related to a catastrophe or declared disaster

GA – ABN was required and obtained

GM – Multiple patient modes of transport

GW – Hospice patient, unrelated to the hospice diagnosis

GX – ABN was optional and obtained

GY – Service that is statutorily excluded

GZ – ABN was required but not obtained

QJ – Incarcerated patient

QL – Patient pronounced dead after ambulance called

QM – Under the arrangement

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Ambulance CPT Codes and Modifiers: A Complete Guide

It is stated that the ambulance service is covered, and can be reimbursed through Medicaid using ambulance modifiers. However, with so many medical billings and claims changes, how are ambulance modifiers utilized properly to avoid strenuous or legal situations?

The use of ambulance modifiers and their meaning will be discussed in more detail in the following section of the article.

Ambulance and Its Work

Everyone knows the purpose of the ambulance. The ambulance service provider provides the facility of an ambulance in such cases where our patient cannot access any other means of transportation and must wait for his vehicle while he is surviving and looking for help to save his life in danger.

How Can Ambulance Modifiers Be Used?

The service of ambulance service is not only for the land but also for the air and water. But here are the covered CPT codes for ground ambulances, which also invoke both water and air transportation. There’s a quick identification of these codes, based on the following facts distance traveled, services given to the patient inside the ambulance, and the patient’s health condition at the time of the ambulance service call.

Below is a list of CPT codes and modifiers used for the ambulance transportation service , along with the short descriptions:

• CPT A0425 – Ground distance per statute mile.
• CPT A0426 – The code is used for non-emergency ambulance transport, advanced life support, and ALS1 level, which includes medical supplies in the ambulance, but these medical supplies do not only include the administration of approved medications, nebulizers, IV Sub Q, peripheral venous puncture, sublingual, and IM.
• CPT A0427 – ALS1 Level 1 emergency, advanced life support, ambulance emergency transport.
• CPT A0428 – Ambulance services, essential life support, and non-emergency transportation (BLS)
• CPT A0429 – Ambulance services, basic life support, and non-emergency transportation (BLS)
• CPT A0433 – Level 2 (ALS2) administration of medically necessary supplies, excluding crystalloid hypotonic and hypertonic solutions, and medically necessary supplies involving at least one of the following procedures: intraosseous line, manual defibrillation, endotracheal intubation, cardiac pacing, surgical airways, chest decompression, and central venous line.
• CPT A0434 – Special Care Transport (SCT)

Ambulance Services Modifiers

Providers affiliated with any medical facility and suppliers of ambulance transport services must provide modifiers referencing the patient’s origin and destination when claiming the ambulance services, they have provided. The HCPCS provides a range of modifiers that can be employed; these modifiers are made up of a combination of alphanumeric characters.

First-Position Ambulance Modifiers: Alpha Code Equals Origin

• Modifier E – Residential, institutional, and domiciliary facility (except the 1819 facility)
• Modifier D – Except for P or H, where the modifier acts as an origin code, Therapeutic site diagnosis
• Modifier G – Hospital-based facility for ESRD
• Modifier H – “Hospital.”
• Modifier I – Patient transfers involve the arrival of transport sites (airport, helipad)
• Modifier J – ESRD freestanding facility
• Modifier N – Facility providing skilled nursing,
• Modifier P – Medical practice
• Modifier R – “Residence.”
• Modifier S – Sudden occurrence or accident
• Modifier X – In case of an emergency, stop at a doctor’s office before going to the hospital.

Ambulance Second Position Modifiers: Alpha Code Equals Destination

• Modifier CR – An ABN was needed and obtained in connection with a disaster or declared disaster.
• Modifier GA – various patient transportation options
• Modifier GM – Different modes of transportation
• Modifier GW – Hospice patient with a diagnosis unrelated to hospice
• Modifier GX – It was optional to obtain an ABN.
• Modifier GY – service that is statutorily excluded.
• Modifier GZ – it was not required to obtain ABN
• Modifier QJ – Patient in prison
• Modifier QL – Patient expired after calling an ambulance
• Modifier QM – Under the agreement

What Takes Place When Incorrect Billing Is Done For Ambulance Transportation?

If the modifier in a billing claim doesn’t tell the ambulance’s origin and destination of the ambulance, then the claim should be considered inappropriate and can be rejected.

For Example, if an emergency ambulance service is called for the patient and the patient reaches the Physician’s clinic from his residence. The claim will be billed under the modifiers of P & R. Where refers to the residence and P refers to the Physician.

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Ambulance Transports: Two Trips on the Same Date of Service

Guidelines and Instructions Submit CPT modifier 76 with ambulance transports (HCPCS codes A0425–A0999) to indicate that a second trip occurred on the same date of service with the same origin/destination modifiers. Or, when the origin/destination modifiers are different but the ambulance transports are submitted with the same HCPCS code.

This modifier should be submitted with each additional trip for same day identical ambulance transport when the transports are:

• On the same date of service
• For the same Medicare beneficiary
• For the same billed amount
• Submitted with the same HCPCS code

Example #1 Two identical, medically necessary round-trip ambulance transports take place for the same beneficiary on the same date of service with the same origin/destination modifiers. In this example, the trips are between a residence and hospital.

• Submit the first round-trip ambulance transport claim with HCPCS code/modifier A0428RH on first detail line and HCPCS code/modifier A0425RH on second detail line
• Submit the second round-trip ambulance transport claim with HCPCS code/modifier and CPT modifier A0428RH76 on first detail line and HCPCS code/modifier and CPT modifier A0425RH76 on the second detail line

Example #2 Two or more identical, medically necessary round-trip ambulance transports take place for the same beneficiary on the same date of service with different origin/destination modifiers. In this example, the trips are between a hospital and skilled nursing facility and hospital to residence.

• Submit the first round-trip ambulance transport claim with HCPCS code/modifier A0428HN on first detail line and HCPCS code/modifier A0425HN on second detail line
• Submit the second round-trip ambulance transport claim with HCPCS code/modifier and CPT modifier A0428HR76 on first detail line and HCPCS code/modifier and CPT modifier A0425RHR76 on the second detail line
• Submit any additional claims after the second trip with the 76 CPT modifier and the applicable origin/destination modifiers

Note: It is important to submit the origin/destination HCPCS modifiers in the first position and CPT modifier 76 in the second position

Important: Supporting documentation must be maintained to support the medical necessity of all ambulance transports. Identical services submitted without the 76 CPT modifier may be denied as a duplicate and will need to be resubmitted with the appropriate modifiers.

Palmetto GBA will not change a code submitted or add any modifier that may be required for payment when processing your claim.

• Beneficiary Notice  
• CMS Ambulance Services Center
• Medicare Benefit Policy Manual, Chapter 10, Ambulance (PDF, 164 KB) 
• Medicare Claims Processing Manual, Chapter 15, Ambulance (PDF, 380 KB)
• §410.40 Coverage of Ambulance Services
• §410.41 Requirements 

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CPT And HCPCS Codes For Ambulance Services

When the patient’s condition is such that any other mode of transportation would risk the patient’s health, ambulance transportation is a recognized service, e.g. suppose a patient has been in a car accident; the ambulance carries the patient to the hospital, and the patient arrives for treatment.

There are CPT codes for ground ambulance services that include both land and water transportation, and the codes are chosen based on the services provided and the patient’s state at the time of transportation.

CPT Codes For Ambulance Services

CPT code A0425: CMS maintains HCPCS code A0425 for Ground distance per statute mile, which falls under Ambulance and Other Transport Services and Supplies.

CPT code A0426: Level (ALS1) ambulance service, advanced life support, non-emergency transport, and provision of at least one ALS intervention, including but not limited to the administration of IV fluids (except blood or blood products), Peripheral venous puncture, blood draws, monitoring potassium-containing IV solutions during transit, administration of approved drugs, IV, Sub Q, sublingual, nebulizer inhalation, IM (limited to deltoid and thigh sites only)

CPT code A0427: A0427 is a valid 2022 HCPCS code for Ambulance service, advanced life support, emergency transport, level 1 (Als1 – emergency), sometimes known as “Als1-emergency” for short.

CPT code A0428: Ambulance service, basic life support, and non-emergency transportation are all available in this code mentioned above.

CPT code A0429: CMS maintains HCPCS Code A0429 for Ambulance service, basic life support, and emergency transport (BLS-emergency), which falls under Ambulance services.

CPT code A0433: Advanced life support, level 2 (ALS2) includes medically necessary supplies and services, and at least three separate administrations of one or more medications via continuous infusion or intravenous push/bolus, isotonic, and hypertonic solutions, or transportation, and the provision of at least one of the following procedures:

• Manual defibrillation/cardioversion
• Endotracheal intubation
• Central venous line
• Cardiac pacing
• Chest decompression
• Surgical airway
• Intraosseous line

CPT code A0434: This code is related to Specialty Care Transport. SCT is defined as hospital-to-hospital transportation of a severely injured or ill beneficiary by ground ambulance vehicle, including the provision of medically necessary supplies and services at a level of service that exceeds the competence of the EMT-Paramedic. SCT is essential when a beneficiary’s condition necessitates continuing care from one or more health professionals in an appropriate specialist field, such as emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with further training.

HCPCS codes For Ambulance Services

These codes range from Ambulance and Other Transportation Services and Supplies. A0021-A0999 is a standardized code set required by Medicare and other health insurance carriers to process healthcare claims.

HCPCS code A0888: According to CMS, HCPCS code A0888 for Noncovered ambulance mileage per mile falls under Ambulance and Other Transport Services and Supplies.

HCPCS code A0021: A0021 is a valid 2022 HCPCS code for Ambulance service, outside state per mile, transport (Medicaid only), sometimes known as “Outside state ambulance service” for short.

HCPCS code A0080: According to CMS, HCPCS code A0080 for Non-emergency transportation, per mile – the vehicle is given by a volunteer (person or group), with no vested interest falls under Ambulance Other Transport Assistances.

HCPCS code A0090: As managed by CMS, HCPCS code A0090 for non-emergency transportation, per mile – vehicle provided by an individual with a vested interest, a falls under Ambulance and Other Transport Services and Supplies.

HCPCS code A0100: This code is for non-emergency transportation like cabs and falls under Ambulance and Other Transport Services and Supplies, according to CMS.

HCPCS code A0120: This code deals with transport Services and Supplies and non-emergency transportation like minibus, mountain area transports, or other transportation systems as managed by CMS falls under ambulance.

HCPCS Code A0130: This is a valid HCPCS code for Non-emergency transportation such as a wheelchair van, also known as “None transport wheelchair van” in an ambulance.

HCPCS Code A0140: This is a valid 2022 HCPCS code for non-emergency transportation and air travel (private or commercial), also known as “non-emergency transport air” in an ambulance.

HCPCS code A0160: According to CMS, this code is for non-emergency transportation: per mile – case worker or social worker falls under ambulance and other transport services and supplies.

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Understanding Origin and Destination Codes in Ambulance Billing

An important ambulance billing best practice is knowing how to code ambulance transport origins and destinations properly. When it comes to identifying proper origin and destination codes in medical billing, it is a common practice to follow the Centers for Medicare and Medicaid (CMS) guidelines for ambulance billing, given most commercial carriers have adopted these guidelines as well. That’s why we referred CMS document to explain origin and destination codes in ambulance billing.

Origin and Destination Codes in Ambulance Billing

For ambulance service claims, institutional-based providers and suppliers must report origin and destination codes for each ambulance trip. Origin and destination codes used for ambulance services are created by combining two alpha characters. Each alpha character, with the exception of “X”, represents an origin code or a destination code. The pair of alpha codes creates one code to be reported in modifier field. The first position alpha code equals origin; the second position alpha code equals destination. The Centers for Medicare & Medicaid Services (CMS) maintains the list of valid codes. Origin and destination codes and their descriptions are as follows: 

• D = Diagnostic or therapeutic site other than P or H when these are used as origin codes;
• E = Residential, domiciliary, custodial facility (other than 1819 facility);
• G = Hospital based ESRD facility;
• H = Hospital;
• I = Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport;
• J = Freestanding ESRD facility;
• N = Skilled nursing facility;
• P = Physician’s office;
• R = Residence;
• S = Scene of accident or acute event;
• X = Intermediate stop at physician’s office on way to hospital (destination code only)

While combinations of these items may duplicate other HCPCS modifiers, when billed with an ambulance transportation code, the reported modifiers can only indicate origin/destination. Beginning with start date of the ET3 Model on January 1, 2021 (and only for as long as the CMS ET3 Model is in effect), CMS is allowing the following alpha character modifiers to be used in the “destination” position of the origin/destination modifier combination on Emergency Triage, Treat, and Transport (ET3) Model ambulance claims to indicate, an allowable alternative destination; or in the case of the beneficiary being treated in place (no transport of the beneficiary occurs):

• C = Community Mental Health Center;
• F = Federally Qualified Health Center;
• = Physician’s Office;
• U = Urgent Care Facility;
• W = Treatment in Place (in person or via telehealth)

Note that these new destination codes are to be used on ET3 Model ambulance claims only and shall not be used, in any circumstance, in the origin code position of an ambulance service line HCPCS origin/destination modifier combination. These codes are only to be used by selected ET3 Model Participants.

Emergency Triage, Treat, and Transport (ET3) Model

Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call. CMS will continue to pay to transport a Medicare FFS beneficiary to a hospital emergency department or other covered destination. In addition, under the model, CMS will pay participants to

• transport to an alternative destination partner, such as a primary care office, urgent care clinic, or a community mental health center (CMHC), or
• initiate and facilitate treatment in place with a qualified health care partner, either at the scene of the 911 emergency response or via telehealth.

The model will allow beneficiaries to access the most appropriate emergency services at the right time and place. As a result, the ET3 Model aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

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• ambulance medical billing
• AmbulanceBilling
• AmbulanceBillingServices
• AmbulanceTransportation
• ClaimDenials
• medicalbilling
• medicalbillingcompany
• medicalbillingservices
• medicalCoding
• Outsource medical billing
• reimbursement
• revenuegrowth

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