Summary & Overview
HCPCS A0426: Ambulance Advanced Life Support Non-Emergency Transport
HCPCS Level II code A0426 denotes advanced life support, non-emergency ground ambulance transport (level 1). This designation applies when ALS-level interventions are provided during a non-emergent transfer, and it is widely used across emergency medical services and hospital transfer workflows. Nationally, accurate coding of ALS non-emergency transports affects facility and EMS billing, utilization monitoring, and payer adjudication for medically necessary transfers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical setting and service definition for A0426, common payer coverage considerations, and what elements typically establish ALS-level care during a non-emergency transport. The publication also highlights benchmarking topics and policy updates that commonly affect ambulance services reimbursement and documentation requirements.
The report is organized to help revenue cycle leaders, EMS billing managers, and policy analysts understand coding intent, payer scope, and the operational implications of billing HCPCS Level II code A0426 for non-emergency ALS transports.
Billing Code Overview
HCPCS Level II code A0426 describes an ambulance service: advanced life support, non-emergency transport, level 1 (ALS 1). This code captures transports in which advanced life support interventions are provided during a non-emergency transfer.
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Service type: Advanced life support, non-emergency transport
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Typical site of service: Ground ambulance transport between healthcare facilities or from a residence to a healthcare facility for non-emergent clinical needs
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult with a chronic cardiac condition requiring scheduled non-emergency interfacility transport to a tertiary hospital for cardiology evaluation and monitoring. Example: a 68-year-old male with ischemic cardiomyopathy and recent decompensated heart failure is medically stable for transport but requires advanced life support capability during transit due to risk of arrhythmia and need for continuous cardiac monitoring and intravenous infusions. The clinical workflow begins with a physician or case manager ordering non-emergency ambulance transport with ALS 1 level. The ambulance provider verifies medical necessity, confirms presence of ALS-trained personnel (paramedic), prepares cardiac monitor/defibrillator, oxygen, IV access supplies, and medications as indicated. On pickup, the paramedic documents baseline vitals, ongoing interventions (cardiac monitoring, IV fluid or medication administration), and any changes en route. On arrival, a transfer report is provided to receiving staff, and documentation supports the ALS level by recording advanced assessment, monitoring, and any ALS-level interventions performed during transport.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
AS | Non‑participating physician certification and notice of admission not required under Medicare | Use when transport involves a beneficiary with applicable certification status for outpatient services under Medicare rules |
CO | Managed care plan contractually obligated payor | Use when the claim is for services covered under a contractor payor arrangement |
CQ | Mileage not used — transport is nonemergency ALS level 1 | Use when reporting ALS nonemergency transport without mileage charge elements (jurisdictional use may vary) |
GA | Data not provided in the input | Data not available in the input |
GY | Item or service statutorily excluded or does not meet the definition of any Medicare benefit | Use when payor denies coverage as excluded service under Medicare policy |
TC | Technical component | Use when separate billing distinguishes technical component for equipment provided by ambulance service (rare) |
QK | Medical direction by physician; more than four patients | Use when ALS transport provided under medical direction with large call volume (ambulance medical direction modifiers vary) |
GJ | Optional — local carrier specific modifier | Use where local Medicare Administrative Contractor requires carrier-specific modifier for ambulance services |
QN | Ambulance service related modifier for quality reporting | Use when reporting specific quality or administrative attributes as required by payor |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
3336C0001X | Paramedic | Primary clinicians staffing ALS ambulance services; credentialing taxonomy for EMS personnel |
261Q00000X | Emergency Medical Services | Organizational taxonomy for ambulance service providers performing ALS transports |
207RC0000X | Internal Medicine | Referring or receiving specialty coordinating non-emergency ALS interfacility transfers |
207RM1200X | Cardiology | Common receiving specialty for cardiac patients requiring ALS-level non-emergency transport |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.33 | Acute on chronic systolic (congestive) heart failure | Common indication for non-emergency ALS transport due to need for monitoring and potential ALS interventions en route |
I21.3 | ST elevation (STEMI) myocardial infarction of unspecified site | Post-stabilization interfacility transfer for specialty care may require ALS capability during transport |
I48.91 | Unspecified atrial fibrillation | Patients with unstable arrhythmia risk may require ALS-trained personnel and continuous monitoring during transfer |
R55 | Syncope and collapse | Recent syncope with cardiogenic concern often necessitates ALS-level monitoring during transport to definitive care |
J96.00 | Acute respiratory failure, unspecified whether with hypoxia or hypercapnia | Respiratory compromise requiring oxygen therapy and potential advanced airway management during transport |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
93000 | Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | Performed before or after transport to document cardiac status when monitoring arrhythmia risk during ALS transport |
93010 | Electrocardiogram interpretation and report only | Used if interpretation is documented separately from ECG acquisition in the clinical workflow surrounding transport |
36415 | Collection of venous blood by venipuncture | May be performed prior to transport to obtain laboratory data guiding management during ALS-level transfer |
99238 | Hospital discharge day management; 30 minutes or less | Used by the sending facility physician for discharge/transfer documentation when patient leaves facility for transport |
99090 | Analysis of clinical data stored and transmitted by patient or device (miscellaneous) | Occasionally used for documentation of remote monitoring data transmitted during interfacility transfer when applicable |