Summary & Overview
HCPCS Level II A0425: Ground mileage for ambulance transport
Headline: HCPCS Level II code A0425: Ground mileage, per statute mile
Lead: HCPCS Level II code A0425 identifies the mileage component of ground ambulance transports and is a key code for documenting distance-based transport charges. It matters nationally as mileage reporting directly affects ambulance claim adjudication, bundled transport billing, and the accurate capture of transport-related costs.
What the code represents and why it matters: This code represents per-mile billing for ground ambulance transports and is an essential element of ambulance service claims. Accurate use of the code influences payment determinations, provider-provider arrangements, and compliance with payor policies.
Key payers covered: Coverage considerations for A0425 are addressed across major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
What readers will learn: The publication provides clear definitions and clinical context for use of HCPCS Level II code A0425, describes how it pairs with base ambulance service lines, and outlines common billing elements and administrative considerations. The reader will find concise guidance on the role of mileage in claims, the typical clinical scenarios that generate transport mileage, and references to related ambulance service categories. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code A0425 denotes ground mileage, per statute mile associated with ambulance and transport services. This code is used to report the mileage component of a ground ambulance transport and is billed in conjunction with the base ambulance transport service line. The service type is Ambulance/Transport Services and the typical site of service is ground ambulance transport.
Clinical & Coding Specifications
Clinical Context
A patient calls emergency services for acute chest pain while at home. Emergency Medical Services (EMS) respond, evaluate the patient on scene, and determine ground ambulance transport to the nearest emergency department is required. During transport, EMS documents total statute miles traveled from pickup location to destination, provides basic or advanced life support as clinically indicated, and records the arranging relationship (service furnished directly or under arrangement). The ground mileage line item accompanies the base transport service code on the claim and is billed using HCPCS Level II code A0425 for the number of statute miles.
Coding Specifications
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Modifiers:
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QM— Ambulance service provided under arrangement. UseQMon the mileage line when the transporting ambulance service is furnished under arrangement by another provider. -
QN— Ambulance service furnished directly by the billing provider. UseQNon the mileage line when the billing ambulance provider furnished the transport directly. -
Provider taxonomies:
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341600000X— Ambulance: represents ambulance service organizations providing patient transport. -
146L00000X— Emergency Medical Technician, Paramedic: represents paramedic-level clinicians who may provide ALS interventions during transport. -
146N00000X— Emergency Medical Technician, Basic: represents basic EMT personnel who provide BLS-level care during transport.
Related Codes
| Code | Description |
|---|---|
A0426 | Ambulance service, Advanced Life Support (ALS), non‑emergency transport, Level 1 |
A0428 | Ambulance service, Basic Life Support (BLS), non‑emergency transport |
A0429 | Ambulance service, basic life support (BLS), emergency transport |
A0434 | Ambulance service, specialty care transport (SCT) |
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A0426: Often billed as the base transport level when ALS interventions are provided;A0425is billed on the same claim to report statute miles traveled. -
A0428: Represents BLS non-emergency base transport;A0425is used with this code to report ground mileage when applicable. -
A0429: Represents BLS emergency transport (emergency response and transport);A0425accompanies this code to bill mileage for the emergency trip. -
A0434: Specialty care transport may require higher-level clinical staffing and equipment;A0425is billed for statute miles in conjunction with this specialty transport code.
Related Diagnoses
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R07.9— Chest pain, unspecifiedClinical relevance: Chest pain is a common emergency symptom prompting ambulance transport and evaluation; ground mileage
A0425documents distance for billing alongside the transport level. -
R55— Syncope and collapseClinical relevance: Loss of consciousness or near-syncope often requires EMS transport for urgent evaluation; mileage is billed with
A0425for the trip distance. -
I21.9— Acute myocardial infarction, unspecifiedClinical relevance: Suspected acute myocardial infarction frequently triggers emergent ground transport;
A0425records statute miles for reimbursement accompanying the base transport code. -
J96.00— Acute respiratory failure, unspecified whether with hypoxia or hypercapniaClinical relevance: Respiratory failure may necessitate urgent ambulance transport with advanced interventions; mileage billed using
A0425accompanies the appropriate service level code. -
S06.0X0A— Concussion without loss of consciousness, initial encounterClinical relevance: Head injuries requiring emergency transport to a hospital are billed with ground mileage
A0425in addition to the transport service code.
National Reimbursement Benchmarks
National mean rates show BUCA (average commercial) with a mean of $10.84 compared with Medicare, for which no mean rate is provided in the input. Aetna reports the highest mean at $22.15 while Cigna Health reports the lowest mean among the listed commercial payers at $5.36.
Rate dispersion (P75 minus P25) is smallest for Cigna Health (4 - 4 = 0) indicating very tight distribution, followed by Aetna (5.33 - 4 = 1.33) and UnitedHealthcare (9 - 7 = 2). Blue Cross Blue Shield shows the widest dispersion (14 - 7 = 7). The table and chart below present the full breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.