A0390 ALS mileage — HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS A0390: ALS mileage (per mile)

HCPCS Level II code A0390 designates ALS mileage (per mile) and is used to bill the distance component of ambulance transports when Advanced Life Support (ALS) services are provided. This code is nationally relevant because mileage billing comprises a significant portion of ambulance reimbursement and affects access, provider revenue flows, and transport cost transparency.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what A0390 represents, typical clinical and operational contexts for use, and the national implications for billing and payment. The publication covers benchmarks and payment considerations, common payer coverage patterns, and the clinical scenarios under which ALS-level mileage is typically reported.

The content provides an operational overview for billing, coding, and policy audiences: where A0390 fits in ambulance service billing, how it interacts with ALS transport documentation and service lines, and areas to monitor for policy or coverage updates. Data not provided in the input (such as specific payer rates, taxonomies, or ICD-10 pairings) is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareA0390HCPCS Level IIambulanceALS mileagemedical transportationbillingreimbursementemergency medical services

Billing Code Overview

HCPCS Level II code A0390 represents ALS mileage (per mile), a transportation billing code used to report mileage for ambulance transports billed at the advanced life support (ALS) level. This code captures the distance-based component of emergency or non-emergency patient transport when ALS services are provided.

Service type: Ground ambulance transport with Advanced Life Support (ALS) level service
Typical site of service: Ground transport between patient locations, such as residence to hospital, hospital to skilled nursing facility, or interfacility hospital transfers.

Clinical & Coding Specifications

Clinical Context

A patient with limited mobility requires non-emergency ambulance ground transportation under advanced life support (ALS) during a transfer between home and a skilled nursing facility for ongoing oxygen-dependent care. The patient has chronic obstructive pulmonary disease with intermittent hypoxemia requiring ALS monitoring and possible medication administration en route. The clinical workflow begins with a physician or qualified practitioner ordering non-emergency ALS ground transport; the ambulance provider documents the medical necessity, mileage from pick-up to destination, ALS interventions performed (e.g., continuous oxygen, IV medication, cardiac monitoring), and the total miles driven. Billing is submitted using the HCPCS Level II code A0390 reported on a per-mile basis, with additional codes for ALS service level and any supplies or distinct ambulance service codes as appropriate. Medical records include the transport record, ALS patient care report, oxygen flow rates, medications administered, and signatures of the transporting crew and ordering practitioner.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When ALS transport required substantially greater services than typical (e.g., prolonged on-scene ALS procedures).

HCPCS A0100: Non-Emergency Transportation, Taxi

HCPCS-A0433-ADVANCED-LIFE-SUPPORT-LEVEL-2-ALS2

HCPCS A0433: Advanced Life Support, Level 2 (ALS 2)

HCPCS-A0225-NEONATAL-EMERGENCY-AMBULANCE-TRANSPORT-BASE-RATE

HCPCS A0225: Neonatal Emergency Ambulance Transport, Base Rate

HCPCS-A0432-PARAMEDIC-INTERCEPT-RURAL-VOLUNTEER-TRANSPORT

HCPCS A0432: Paramedic Intercept, Rural Volunteer Ambulance Transport

HCPCS-A0435-FIXED-WING-AIR-MILEAGE-PER-STATUTE-MILE

HCPCS A0435: Fixed-Wing Air Mileage, Per Statute Mile

HCPCS-A0021-AMBULANCE-SERVICE-OUTSIDE-STATE-PER-MILE-TRANSPORT

HCPCS A0021: Ambulance Service Outside State, Per-Mile Transport

HCPCS-A0424-EXTRA-AMBULANCE-ATTENDANT-GROUND-AIR-TRANSPORT

HCPCS A0424: Extra Ambulance Attendant for Ground or Air Transport

HCPCS-A0428-AMBULANCE-BLS-NON-EMERGENCY-TRANSPORT

HCPCS A0428: Ambulance BLS Non-Emergency Ground Transport

HCPCS-A0090-NON-EMERGENCY-TRANSPORTATION-MILE-PRIVATE-VEHICLE

HCPCS A0090: Non-Emergency Transportation, Per Mile (Private Vehicle)

HCPCS-A0110-NON-EMERGENCY-BUS-TRANSPORTATION

HCPCS A0110: Non-Emergency Bus or Carrier Transportation

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Taxonomy Code	Specialty	Notes
335N00000X	Paramedic	Primary providers performing ALS ground transport.
3336P0800X	Emergency Medical Technician	Ambulance crew members who perform transport and basic/advanced life support interventions.
207P00000X	Emergency Medicine Physician	Ordering and medical oversight for non-emergency ALS transports.
261QM0800X	Critical Care Medicine	Physicians managing high-acuity patients that require ALS-level transport.
163W00000X	Pulmonary Disease	Common clinical specialty ordering ALS transport for respiratory compromise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J44.1`	Chronic obstructive pulmonary disease with (acute) exacerbation	COPD exacerbation frequently necessitates ALS monitoring and oxygen during transport.
`I50.9`	Heart failure, unspecified	Acute decompensated heart failure may require ALS-level monitoring and interventions en route.
`R06.02`	Shortness of breath	Common presenting symptom prompting ALS ground transport with oxygen and monitoring.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Respiratory failure often requires ALS interventions during transport.
`A41.9`	Sepsis, unspecified organism	Patients with sepsis may need ALS monitoring and IV access during interfacility transfer.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99223`	Initial hospital inpatient consultation, high severity	May document inpatient medical decision-making that orders interfacility ALS transport.
`99238`	Hospital discharge day management	Discharge planning documentation can include orders for ALS transport to post-acute care.
`94640`	Pressurized or non-pressurized inhalation treatment for acute airway obstruction	Performed before or during transport for patients with respiratory distress requiring ALS-level care.
`31500`	Emergency endotracheal intubation, without direct laryngoscopy	ALS crews may perform airway interventions documented alongside mileage billing.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; interpretation and report	Cardiac monitoring performed during ALS transport and documented in the transport record.

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