Ambulance CPT Codes and Modifiers: A Complete Guide

It is stated that the ambulance service is covered, and can be reimbursed through Medicaid using ambulance modifiers. However, with so many medical billings and claims changes, how are ambulance modifiers utilized properly to avoid strenuous or legal situations?

The use of ambulance modifiers and their meaning will be discussed in more detail in the following section of the article.

Ambulance and Its Work

Everyone knows the purpose of the ambulance. The ambulance service provider provides the facility of an ambulance in such cases where our patient cannot access any other means of transportation and must wait for his vehicle while he is surviving and looking for help to save his life in danger.

How Can Ambulance Modifiers Be Used?

The service of ambulance service is not only for the land but also for the air and water. But here are the covered CPT codes for ground ambulances, which also invoke both water and air transportation. There’s a quick identification of these codes, based on the following facts distance traveled, services given to the patient inside the ambulance, and the patient’s health condition at the time of the ambulance service call.

Below is a list of CPT codes and modifiers used for the ambulance transportation service, along with the short descriptions:

CPT A0425 – Ground distance per statute mile.
CPT A0426 – The code is used for non-emergency ambulance transport, advanced life support, and ALS1 level, which includes medical supplies in the ambulance, but these medical supplies do not only include the administration of approved medications, nebulizers, IV Sub Q, peripheral venous puncture, sublingual, and IM.
CPT A0427 – ALS1 Level 1 emergency, advanced life support, ambulance emergency transport.
CPT A0428 – Ambulance services, essential life support, and non-emergency transportation (BLS)
CPT A0429 – Ambulance services, basic life support, and non-emergency transportation (BLS)
CPT A0433 – Level 2 (ALS2) administration of medically necessary supplies, excluding crystalloid hypotonic and hypertonic solutions, and medically necessary supplies involving at least one of the following procedures: intraosseous line, manual defibrillation, endotracheal intubation, cardiac pacing, surgical airways, chest decompression, and central venous line.
CPT A0434 – Special Care Transport (SCT)

Ambulance Services Modifiers

Providers affiliated with any medical facility and suppliers of ambulance transport services must provide modifiers referencing the patient’s origin and destination when claiming the ambulance services, they have provided. The HCPCS provides a range of modifiers that can be employed; these modifiers are made up of a combination of alphanumeric characters.

First-Position Ambulance Modifiers: Alpha Code Equals Origin

Modifier E – Residential, institutional, and domiciliary facility (except the 1819 facility)
Modifier D – Except for P or H, where the modifier acts as an origin code, Therapeutic site diagnosis
Modifier G – Hospital-based facility for ESRD
Modifier H – “Hospital.”
Modifier I – Patient transfers involve the arrival of transport sites (airport, helipad)
Modifier J – ESRD freestanding facility
Modifier N – Facility providing skilled nursing,
Modifier P – Medical practice
Modifier R – “Residence.”
Modifier S – Sudden occurrence or accident
Modifier X– In case of an emergency, stop at a doctor’s office before going to the hospital.

Ambulance Second Position Modifiers: Alpha Code Equals Destination

Modifier CR – An ABN was needed and obtained in connection with a disaster or declared disaster.
Modifier GA – various patient transportation options
Modifier GM – Different modes of transportation
Modifier GW – Hospice patient with a diagnosis unrelated to hospice
Modifier GX – It was optional to obtain an ABN.
Modifier GY – service that is statutorily excluded.
Modifier GZ – it was not required to obtain ABN
Modifier QJ – Patient in prison
Modifier QL – Patient expired after calling an ambulance
Modifier QM – Under the agreement

What Takes Place When Incorrect Billing Is Done For Ambulance Transportation?

If the modifier in a billing claim doesn’t tell the ambulance’s origin and destination of the ambulance, then the claim should be considered inappropriate and can be rejected.

For Example, if an emergency ambulance service is called for the patient and the patient reaches the Physician’s clinic from his residence. The claim will be billed under the modifiers of P & R. Where refers to the residence and P refers to the Physician.