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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.

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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.

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HCPCS A0390: ALS mileage (per mile)

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Billing Code Overview

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).
`23`	Unusual anesthesia	Not typically used for ambulance mileage; included if applicable per payer for unusual sedation/anesthesia events during transport.
`52`	Reduced services	When ALS transport provided but services were partially reduced relative to typical ALS transport.
`53`	Discontinued procedure	If transport was begun but aborted for patient safety and mileage is limited.
`56`	Preoperative management only	Rare for transport; use only if transport limited to preoperative evaluation without full ALS interventions.
`62`	Two surgeons	Not typical for ambulance mileage; occasionally used by specialty billing partners when dual-provider coordination affects charge split.
`78`	Return to operating room following prior procedure	Not typical for ambulance mileage; include only if specifically required by a payer policy.
`80`	Assistant surgeon	Not typically applicable to ambulance mileage; included for completeness when billing systems require it.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not applicable to mileage but may appear in modifier lists for related professional claims.

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.

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

HCPCS-A0080-VOLUNTEER-NON-EMERGENCY-TRANSPORTATION-MILEAGE

HCPCS Level II A0080: Non-Emergency Volunteer Transportation, Per Mile

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

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

HCPCS-A0100-NON-EMERGENCY-TAXI-TRANSPORTATION

HCPCS A0100: Non-Emergency Transportation, Taxi

HCPCS-A0110-NON-EMERGENCY-BUS-TRANSPORTATION

HCPCS A0110: Non-Emergency Bus or Carrier Transportation

HCPCS-A0120-NON-EMERGENCY-MINI-BUS-TRANSPORTATION

HCPCS A0120: Non-Emergency Mini-Bus and Specialized Transport

HCPCS-A0130-WHEELCHAIR-VAN-NON-EMERGENCY-TRANSPORTATION

HCPCS Level II A0130: Non-Emergency Wheelchair Van Transport

HCPCS-A0140-NON-EMERGENCY-AIR-TRANSPORTATION

HCPCS A0140: Non-Emergency Air Transportation (Private or Commercial)

HCPCS-A0160-NON-EMERGENCY-TRANSPORTATION-CASE-WORKER-SOCIAL-WORKER-PER-MILE

HCPCS A0160: Non-Emergency Transportation Per Mile by Case or Social Worker

HCPCS-A0180-ANCILLARY-LODGING-NON-EMERGENCY-TRANSPORTATION

HCPCS A0180: Non-Emergency Transportation Ancillary Lodging

Showing 1–10 of 40

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

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).
`23`	Unusual anesthesia	Not typically used for ambulance mileage; included if applicable per payer for unusual sedation/anesthesia events during transport.
`52`	Reduced services	When ALS transport provided but services were partially reduced relative to typical ALS transport.
`53`	Discontinued procedure	If transport was begun but aborted for patient safety and mileage is limited.
`56`	Preoperative management only	Rare for transport; use only if transport limited to preoperative evaluation without full ALS interventions.
`62`	Two surgeons	Not typical for ambulance mileage; occasionally used by specialty billing partners when dual-provider coordination affects charge split.
`78`	Return to operating room following prior procedure	Not typical for ambulance mileage; include only if specifically required by a payer policy.
`80`	Assistant surgeon	Not typically applicable to ambulance mileage; included for completeness when billing systems require it.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not applicable to mileage but may appear in modifier lists for related professional claims.

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.

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

HCPCS-A0080-VOLUNTEER-NON-EMERGENCY-TRANSPORTATION-MILEAGE

HCPCS Level II A0080: Non-Emergency Volunteer Transportation, Per Mile

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

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

HCPCS-A0100-NON-EMERGENCY-TAXI-TRANSPORTATION

HCPCS A0100: Non-Emergency Transportation, Taxi

HCPCS-A0110-NON-EMERGENCY-BUS-TRANSPORTATION

HCPCS A0110: Non-Emergency Bus or Carrier Transportation

HCPCS-A0120-NON-EMERGENCY-MINI-BUS-TRANSPORTATION

HCPCS A0120: Non-Emergency Mini-Bus and Specialized Transport

HCPCS-A0130-WHEELCHAIR-VAN-NON-EMERGENCY-TRANSPORTATION

HCPCS Level II A0130: Non-Emergency Wheelchair Van Transport

HCPCS-A0140-NON-EMERGENCY-AIR-TRANSPORTATION

HCPCS A0140: Non-Emergency Air Transportation (Private or Commercial)

HCPCS-A0160-NON-EMERGENCY-TRANSPORTATION-CASE-WORKER-SOCIAL-WORKER-PER-MILE

HCPCS A0160: Non-Emergency Transportation Per Mile by Case or Social Worker

HCPCS-A0180-ANCILLARY-LODGING-NON-EMERGENCY-TRANSPORTATION

HCPCS A0180: Non-Emergency Transportation Ancillary Lodging

Showing 1–10 of 40

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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HCPCS A0390: ALS mileage (per mile)

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Billing Code Overview

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HCPCS A0390: ALS mileage (per mile)

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References