Reimbursement Update: Ambulance Services

In preparation for the provision of the No Surprises Act effective January 1, 2022, updates have been made to the Ambulance Services reimbursement policy. To meet the requirement to submit data on air ambulance services to the Tri-agencies, providers are asked to use the appropriate Healthcare Common Procedure Coding System (HCPCS) codes to identify whether the transport was emergent or non-emergent. If an ambulance service is billed using an emergent code and medical documentation does not support the code billed, the claim will be denied as “documentation doesn’t support” and the claim should be re-billed with the correct HCPCS code.


CodeDescription
A0430Ambulance Service, conventional air services, transport, one way (fixed wing)
A0431Ambulance Service, conventional air services, transport, one way (rotary wing)
S9960Ambulance service, conventional air services, nonemergency transport, one way (fixed wing)
S9961Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)
A0998Ambulance response and treatment, no transport


If an ambulance service is billed using an emergent code and medical documentation does not support the code billed, the claim will be denied as documentation doesn’t support. The claim should be rebilled with the correct HCPCS code.