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How Are Ambulance Modifiers Used? Learn About Ambulance CPT Codes and Modifiers

How are ambulance modifiers used Learn about Ambulance CPT Codes and Modifiers

Who doesn’t know the purpose of ambulances? Ambulance service providers are covered with the ambulance service in cases where the patient could not access any other means of transportation and waiting for the availability of a personal vehicle can put the life or health of the patient in danger.

As it is said that the ambulance service is covered, the service can be reimbursed through Medicaid using ambulance modifiers. But with so many amendments in the medical billing and claiming, how are ambulance modifiers used correctly so you must not bump into challenging or legal situations.

In the next part of the article, we’ll explore how you can use the ambulance modifiers and what they tell you.

How are ambulance modifiers used?

Ambulances are not just meant to be a function of the land but in the air and on the water as well. But the covered CPT codes are for the ground ambulances which refer to both water and land ambulance transportations. These codes are identified concisely on the basis of the distance traveled, services rendered inside the ambulance, and the health of the patient at the time of the ambulance service call.

Here’s a list of CPT codes and modifiers used for the service of ambulance transportation with their short descriptions;

  •  CPT A0425 – Ground mileage per statute mile.
  •  CPT A0426 – The code is used for ambulance service non-emergency transport, advanced life support, and ALS1 level which include medical supplies in the ambulance but these medical supplies do not limit themselves in the provision of IV fluids such as blood or products taken out of blood (plasma), Administration of approved medication, nebulizers, IV Sub Q, Peripheral venous puncture, sublingual, IM.
  • CPT A0427 – advanced life support, ambulance emergency transport, ambulance service, ALS1 Level 1 emergency.
  • CPT A0428 – Basic life support, ambulance service, non-emergency transport (BLS)
  • CPT A0429 – Basic life support, ambulance service, non-emergency transport (BLS)
  • CPT A0433 – Level 2 (ALS2) provision of the administration of medically necessary supplies excluding crystalloid hypotonic, and hypertonic solution, medically necessary supplies that include at least one of the procedures from Central venous line, Manual defibrillation, Endotracheal intubation, Cardiac pacing, surgical airways, chest decompression, intraosseous line.
  • CPT A0434 – SCT – Special Care Transport
How are ambulance modifiers used

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Modifiers for ambulance services

For claiming the ambulance services rendered, the providers connected to any medical institution and the suppliers of the ambulance transport services must use the modifiers referring to the destination and origin of a patient. The modifiers used should be from the range provided in the HCPCS which are created using the combination of alphanumeric characters.

First position modifiers for ambulances – Alpha code Equals origin

  • Modifier E – domiciliary, residential, custodial facility (except 1819 facility)
  • Modifier D – Therapeutic site diagnosis except for P or H when the modifier is acting like an origin code
  • Modifier G – ESRD – Hospital-based facility
  • Modifier H – Hospital
  • Modifier I – Transport sites come along with the transfer of the patient (airport, helipad)
  • Modifier J – ESRD freestanding facility
  • Modifier N – Facility providing skilled nursing
  • Modifier P – Physician’s office
  • Modifier R – Residence
  • Modifier S – Acute event or accident
  • Modifier X – Stop at a physician’s office in an emergency on the way to the hospital

Second position modifiers for ambulances – Alpha code Equals Destination

  • Modifier CR: Related to a catastrophe or declared disaster
  • Modifier GA: ABN was required and obtained
  • Modifier GM: Multiple patient modes of transport
  • Modifier GW: Hospice patient, unrelated to the hospice diagnosis
  • Modifier GX: ABN was optional and obtained
  • Modifier GY: Service that is statutorily excluded
  • Modifier GZ: ABN was required but not obtained
  • Modifier QJ: Incarcerated patient
  • Modifier QL: Patient pronounced dead after ambulance called
  • Modifier QM: Under the arrangement

What happens when inappropriate billing is made against ambulance transportation

If the billing claim has a modifier that does not describe the destination and origin of the ambulance, the claim would be considered inappropriate and the claim could be rejected.

For instance, if an emergency ambulance service is called and the patient is transported from his residence to the physician’s office, the claim for the service will be billed under the modifiers P and R. Where P refers to a physician and R refers to a resident.