Ambulance Services - Ground
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This policy governs coverage and billing requirements for ground ambulance (BLS and ALS) emergency and non-emergency transports for Blue Cross Blue Shield of Rhode Island members.
No material clinical or coverage changes in this revision.
Coverage Criteria for Ground Ambulance Services
Emergency Transport Coverage
Emergency transports covered when ALL of the following apply:
Claims for patients pronounced dead after ambulance call must be filed with modifier QL (Patient pronounced dead after ambulance called).
Non-Emergency Transport Coverage
Non-emergency transports coverage varies by product and when ALL of the following are met:
Examples of contraindications include medically unstable, comatose, requires airway or cardiac monitoring, or ventilator dependence.
Members residing in a SNF: transports to or from diagnostic or therapeutic sites (IDTF, cancer treatment center, radiation therapy center, wound care center) are covered if bed confined.
Wheelchair-assisted ground ambulance services and a set of specified non-emergency transportation HCPCS codes are not covered. Examples of non-covered codes include A0021, A0080–A0160 and specifically A0130 (wheelchair van). These codes are listed as non-covered for both Medicare Advantage and Commercial products and are excluded from payment under this policy.
Certain ancillary ambulance-related HCPCS and CPT codes are recognized by the policy but are not separately reimbursed. Examples called out include ancillary lodging and meal codes (A0180, A0190, A0200, A0210), non-transport response and treatment (A0998), paramedic intercept and related non-transport codes (A0432, S0207, S0208), routine and specialized disposable supply and mileage codes (A0382, A0390, A0392, A0394, A0396, A0398), and selected ECG procedure codes (93005, 93041). See the coding section for the full list and status of each code.
The policy requires origin and destination modifiers to be appended to ambulance HCPCS codes; absence of the two‑digit origin/destination modifiers may cause claim denial. In addition, specific destination modifier combinations are explicitly excluded from coverage: for Medicare Advantage the combinations EP, PE, RP, PR, NP, PN are not covered; for Commercial products the combinations EP, PE, RP, PR, NP, PN, RG, GR, RJ, JR are not covered. Claims submitted with these destination modifier combinations are not payable and may be denied.
Ambulance transport is not payable when other means of transportation could be used without endangering the individual’s health. Medical necessity for ambulance transport is established only when the patient’s condition contraindicates the use of any other method of transportation. Documentation must be retained and presented upon request; a physician order alone does not prove medical necessity. For non-emergency bed‑confined transports, coverage applies only when the member meets the policy definition of bed confined and other requirements (for example, destination restrictions and product‑specific rules) are satisfied.
Coding and Billing
| A0225 | Ambulance service; Neonatal transport, base rate, emergency transport, one way. |
| A0425 | Ground mileage, per statute mile. |
| A0426 | Ambulance service, advanced life support, non-emergency transport, Level 1 (ALS1). |
| A0427 | Ambulance service, advanced life support, emergency transport, Level 1 (ALS1- emergency). |
| A0428 | Ambulance service, basic life support, non-emergency transport (BLS). |
| A0429 | Ambulance service, basic life support, emergency transport (BLS-emergency). |
| A0433 | Advanced life support, Level 2 (ALS2). |
| A0434 | Specialty care transport (SCT). |
| A0021 | Ambulance service; outside state per mile, transport. |
| A0080 | Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization). |
| A0090 | Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest. |
| A0100 | Non-emergency transportation; taxi. |
| A0110 | Non-emergency transportation and bus, intrastate or interstate carrier. |
| A0120 | Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems. |
| A0130 | Non-emergency transportation: wheelchair van. |
| A0140 | Non-emergency transportation and air travel (private or commercial) intrastate or interstate. |
| A0160 | Non-emergency transportation: per mile case worker or social worker. |
| A0180 | Non-emergency transportation; ancillary: lodging-recipient. |
| A0190 | Non-emergency transportation; ancillary: meals recipient. |
| A0200 | Non-emergency transportation; ancillary: lodging escort. |
| A0210 | Non-emergency transportation; ancillary: meals escort. |
| A0432 | Paramedic intercept (PI), rural area transport furnished by a volunteer ambulance company which is prohibited by state law from billing third-party payers. |
| A0888 | Non-covered ambulance mileage. |
| A0998 | Ambulance response and treatment, no transport. |
| S0209 | Wheelchair van, mileage, per mile. |
| A0382 | BLS mileage (per mile) / BLS routine disposable supplies. |
| A0384 | BLS specialized service disposable supplies, defibrillation. |
| EP | destination modifier EP (not covered for Medicare Advantage) |
| PE | destination modifier PE (not covered for Medicare Advantage) |
| RP | destination modifier RP (not covered for Medicare Advantage) |
| PR | destination modifier PR (not covered for Medicare Advantage) |
| NP | destination modifier NP (not covered for Medicare Advantage) |
| PN | destination modifier PN (not covered for Medicare Advantage) |
| EP | destination modifier EP (not covered for Commercial products) |
| PE | destination modifier PE (not covered for Commercial products) |
| RP | destination modifier RP (not covered for Commercial products) |
| PR | destination modifier PR (not covered for Commercial products) |
| NP | destination modifier NP (not covered for Commercial products) |
| PN | destination modifier PN (not covered for Commercial products) |
| RG | destination modifier RG (not covered for Commercial products) |
| GR | destination modifier GR (not covered for Commercial products) |
| RJ | destination modifier RJ (not covered for Commercial products) |
| JR | destination modifier JR (not covered for Commercial products) |
Provider Actions and Documentation Requirements
PRIOR AUTHORIZATION
Prior authorization review is not required.
Medical necessity documentation
BCBSRI follows the CMS definition of medical necessity. Documentation establishing that the patient's condition contraindicates any other method of transportation must be retained and presented upon request. A physician order alone does not establish medical necessity; the ambulance service must meet all program coverage criteria and the transport must be to or from a Medicare-covered service when applicable.
Mileage reporting documentation
Beginning with dates of service on or after January 1, 2011, for electronic claims mileage must be reported as fractional units for trips up to 100 covered miles (round up to the nearest tenth, e.g., 99.9). For trips of 100 miles or greater, report whole miles rounded up (no decimal). For trips under 1 mile, enter a leading zero before the decimal (e.g., 0.9).
Missing modifiers may cause denial
BCBSRI requires origin and destination two-digit HCPCS ambulance modifiers be appended to all ambulance HCPCS codes. Absence of the two-digit origin/destination modifier pair may cause the claim to deny.
- Append both origin and destination modifiers to all ambulance HCPCS codes on claims.
Disallowed modifier combinations
Certain destination modifier combinations are not covered and may result in denial. For Medicare Advantage products the following destination modifier combinations are not covered: EP, PE, RP, PR, NP, PN. For Commercial products the following destination modifier combinations are not covered: EP, PE, RP, PR, NP, PN, RG, GR, RJ, JR.
- Medicare Advantage disallowed combos: EP, PE, RP, PR, NP, PN
- Commercial disallowed combos: EP, PE, RP, PR, NP, PN, RG, GR, RJ, JR
Reference documentation
The following references provide additional guidance on ambulance billing, modifiers, and state requirements: BCBSRI Medical Claims Processing Manual Chapter 6 and Chapter 10; Rhode Island General Laws Title 27; Medicare Claims Processing Manual Chapter 15 - Ambulance.
Key Definitions
Background
Ground ambulance services are provided at multiple levels, most commonly Basic Life Support (BLS) and Advanced Life Support (ALS). An emergency ambulance service is one provided for a sudden onset medical condition with acute symptoms such that lack of immediate attention could reasonably be expected to place the patient’s health, bodily function, or an organ in serious jeopardy. Non-emergency (bed‑confined) transports are evaluated under separate criteria and are covered only when the patient meets the policy definition of bed confined and other coverage conditions are met.
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