Ambulance Fee Schedule
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This document lists West Virginia Medicaid reimbursement rates and notes for ambulance and related transportation HCPCS codes effective 4/1/2026–3/31/2027 and applies to providers billing WV Medicaid for ambulance services.
No material clinical or coverage changes in this revision.
Ambulance Fee Schedule — Coverage and Payment Notes
Fee schedule entries and notes
Payment rates and code-specific notes (including Medicare coverage status or SPA references) as listed below:
ALL of the following
Selected non-emergency/other ground codes
- A0021 — Outside state ambulance service. WV Medicaid rate = 350. Notes: Not Medicare covered.
- A0120 — Non emergency transport mini-bus. WV Medicaid rate = 9 (modifier .) or 5.95 (modifier HE). Notes: Not Medicare covered.
- A0160 — Non emergency transport case worker. WV Medicaid rate = 0.56 (per mile) for modifiers ., HE, U1–U4, UB. Notes: Per mile.
Ground, ALS, BLS, and mileage codes
- A0422 — Ambulance O2 life sustaining. WV Medicaid rate = 25. Notes: Not Medicare covered.
- A0425 — Ground mileage. WV Medicaid rate = 9.42. Notes: 100% Medicare; SPA change WV-22-0022.
- A0426 — ALS 1. WV Medicaid rate = 319.46. Notes: 100% Medicare; SPA change WV-22-0022.
- A0427 — ALS 1 — emergency. WV Medicaid rate = 505.82. Notes: 100% Medicare; SPA change WV-22-0022.
- A0428 — BLS. WV Medicaid rate = 266.22. Notes: 100% Medicare; SPA change WV-22-0022.
- A0429 — BLS — emergency. WV Medicaid rate = 425.95. Notes: 100% Medicare; SPA change WV-22-0022.
Air transport and air mileage
- A0430 — Fixed wing air transport. WV Medicaid rate = 2,706.51. Notes: 50% Medicare.
- A0431 — Rotary wing air transport. WV Medicaid rate = 3,146.73. Notes: 50% Medicare.
- A0435 — Fixed wing air mileage. WV Medicaid rate = 8.22. Notes: 50% Medicare.
- A0436 — Rotary wing air mileage. WV Medicaid rate = 21.93. Notes: 50% Medicare.
Other ambulance and related codes
- A0433 — ALS 2. WV Medicaid rate = 732.10. Notes: 100% Medicare; SPA change WV-22-0022.
- A0434 — Specialty care transport. WV Medicaid rate = 865.21. Notes: Effective 9/1/20 with CR 33556.
- A0998 — Ambulance response/treatment. WV Medicaid rate = 89.18 (modifier .) and 43.44 (modifier HF). Notes: Effective 3/18/20 with CR 32696; Not Medicare covered.
- H0050 — Alcohol/drug service, 15 min. WV Medicaid rate = 14.35 (modifier HF). Notes: Not Medicare covered.
- S0207 — Paramedic intercept non-hospital. WV Medicaid rate = 265.50. Notes: Not Medicare covered.
- S0208 — Paramedic intercept non-voluntary. WV Medicaid rate = 265.50. Notes: Not Medicare covered.
- S0215 — Non emergency transport mileage. WV Medicaid rate = 0.66. Notes: Per mile.
Provider action / effective dates
Covered Codes and Medicare Linkage
Effective Dates and Provider Notes
Fee schedule effective dates and code-opening note
Ambulance Fee Schedule effective 4/1/26 - 3/31/27; no new codes opened as of 1/1/26.
Key Code Definitions
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