CurrentUnitedHealthcarePolicy N/A

Ambulance transportation reimbursement

Governs UnitedHealthcare Community Plan Medicaid reimbursement for ambulance services, including eligible suppliers, required modifiers, bundled services, ALS2 criteria, ESRD reductions, and state-specific exceptions affecting payment. Affects providers billing ambulance and related services on CMS-1500/UB-04.

Policy Summary

PayerUnitedHealthcare

PolicyAmbulance transportation reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionObtain authorization for H0035 when billed with specified transportation codes per state rules (e.g., New Jersey).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

23%ESRD reduction

3+ALS2 IV meds required

two-digitOrigin/destination modifier

CMS-alignedCMS alignment

Coverage criteria and billing rules

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.

Coverage requirements

Only Ambulance Suppliers are eligible for reimbursement of ambulance HCPCS codes A0021 and A0225-A0999; non-ambulance providers must report appropriate CPT/HCPCS codes for non-ambulance services.
Ambulance transportation codes will be reimbursed only when reported with a valid two-digit origin and destination modifier; services reported without a valid two-digit ambulance modifier will be denied. When 'X' is present it must be in the second digit position preceded by a valid origin digit; 'X' in the first position causes denial.
Services including, but not limited to, oxygen, drugs, extra attendants, supplies, EKG, and night differential are considered part of the general ambulance service and are not paid separately when provided by the Same Ambulance Supplier on the same date of service (bundled services).
Ambulance trips to or from a facility for diagnostic tests or specialty treatment reported with modifiers HH, DH or HD that overlap inpatient stay dates (excluding admission and discharge dates) are not reimbursed.

ALS2 criteria

ALS2 is defined per CMS as ground ambulance transport with either: (1) at least three separate administrations of one or more medications by IV push/bolus or continuous infusion (excluding crystalloid fluids), OR (2) provision of at least one listed ALS2 procedure (e.g., manual defibrillation/cardioversion, endotracheal intubation, central venous line, cardiac pacing, surgical airway, chest decompression, intraosseous line).
Reimbursement for ALS2 is based on the level of service provided, not the vehicle used.

ESRD reduction

A 23% reimbursement reduction is applied to nonemergency BLS code A0428 and associated mileage A0425 for transports to/from renal dialysis when a 'G' (hospital-based ESRD) or 'J' (freestanding ESRD facility) modifier appears in either origin or destination position.
State-specific exceptions may exempt a state from the ESRD reduction or modify payable codes and bundled rules; providers must consult state exceptions and attachments for details.

Operational billing notes

UnitedHealthcare Community Plan will not reimburse non-Ambulance Suppliers for rendering ambulance services; only eligible Ambulance Suppliers should bill ambulance HCPCS in the A0021 and A0225-A0999 ranges.
Refer to attachments for the Ambulance Transportation Codes, Ambulance Bundled Codes, and the Ambulance Modifiers lists when preparing claims; codes submitted without the required modifier or submitted as separately payable when bundled will be denied or not reimbursed.

Codes, modifiers, and coding rules

Ambulance supplier-reportable HCPCSHCPCSCovered

A0021, A0225-A0999

HCPCS range that UnitedHealthcare Community Plan will reimburse only when reported by eligible Ambulance Suppliers

Ambulance origin/destination modifiersmixedCovered

Two-digit origin/destination modifiers

Required two-character ambulance origin/destination modifier for ambulance transportation codes; codes without valid two-digit modifier will be denied

Bundled servicesHCPCSNot Covered

Ambulance bundled codes

Lists of codes not separately reimbursed when provided by the Same Ambulance Supplier on same date of service

inv-05: ALS2 medication administrations — requirement detail

Medication administrations requiredAt least three separate administrations of one or more medications by IV push/bolus or by continuous infusion (excluding crystalloid fluids)

Alternative ALS2 procedureProvision of at least one listed ALS2 procedure (e.g., manual defibrillation/cardioversion, endotracheal intubation, central venous line, cardiac pacing, surgical airway, chest decompression, intraosseous line)

Exclusion noteCrystalloid fluids are excluded from the medication administration count for ALS2 determination

Reimbursement basisReimbursement is based on the level of service provided (ALS2) rather than the vehicle used

Provider actions and authorization requirements

Prior Authorization

Prior authorization may be required for H0035 when billed with transportation codes

Some states require prior authorization when H0035 (Community Psychiatric Supportive Treatment) is billed with certain ambulance/transportation codes. Providers should obtain authorization per state-specific UnitedHealthcare guidance before submitting claims when H0035 is reported with applicable transportation codes to avoid denials or payment delays.

Affected code: H0035
Action: Obtain prior authorization per state-specific payer guidance when H0035 is billed with ambulance/transportation codes (see state attachments/modifier lists)
States with specific modifier lists referenced in source: Hawaii, Missouri, New Jersey, Ohio, Tennessee, Texas

Definitions

inv-07: ALS2 — definition of Advanced Life Support, Level 2.

DefinitionAdvanced Life Support, Level 2 (ALS2) is ground ambulance transport with medically necessary supplies and services including either (1) at least three separate IV medication administrations (excluding crystalloids) or (2) provision of at least one specified ALS2 procedure

Staffing requirementALS vehicles must be staffed by at least two people, one of whom must be certified as an EMT-Intermediate or EMT-Paramedic per state/local authority

Example proceduresListed ALS2 procedures include manual defibrillation/cardioversion; endotracheal intubation; central venous line; cardiac pacing; surgical airway; chest decompression; intraosseous line

Payment principleIn alignment with CMS, reimbursement is determined by the level of service furnished, not by the vehicle used

inv-08: Same Ambulance Supplier — definition describing same Federal Tax Identification Number.

DefinitionSame Ambulance Supplier: Ambulance Suppliers of the same specialty reporting the same Federal Tax Identification Number

Implication for bundled servicesServices provided by the Same Ambulance Supplier on the same date of service may be considered bundled and not separately reimbursable

Billing relevanceUsed to determine when certain codes or supplies are included in the ambulance payment versus separately billable

inv-09: BLS — definition of Basic Life Support.

DefinitionBasic Life Support (BLS) is transportation by ground ambulance vehicle and the provision of medically necessary supplies and services, including BLS ambulance services as defined by the State

Staffing requirementBLS ambulances must be staffed by at least two people, with at least one certified as an EMT-Basic by the State or local authority

ScopeBLS covers non-advanced interventions and supplies appropriate to EMT-Basic scope per state/local laws