Specialties / Services FAQs

Yes, you can bill for a round trip ambulance service as long as it meets all requirements for a medically necessary ambulance service. If the point of pickup (POP) zip code is the same then the round trip can be billed on the same claim, if not two separate claims must be submitted.

Example (same POP zip code; same claim):

If you transport a Medicare patient from their residence (R) to hospital (H), report the appropriate ambulance transport Healthcare Common Procedure Coding System (HCPCS) code (AXXXX) and mileage code A0425 with modifiers RH (residence to hospital) appended to each code. The number of loaded miles is reported with the mileage code.

The return trip is reported with the appropriate HCPCS ambulance code and mileage code A0425 with modifiers HR (hospital to residence) appended to each code. The number of loaded miles is reported with the mileage code.

There will be a total of four lines billed.

Example (different POP zip codes; two separate claims):

If you transport a Medicare patient from their residence to hospital, report the appropriate ambulance transport HCPCS code and mileage code A0425 with modifiers RH appended to each code. The number of loaded miles is reported with the mileage code.

The return trip is billed on the second claim. Report the appropriate HCPCS ambulance code and mileage code A0425 with modifiers HR appended to each code. The number of loaded miles is reported with the mileage code.

Reference:

• CMS IOM Pub. 100-04, Claims Processing Manual, Chapter 15, sections 30.1 & 30.2

  Note: Part B ambulance suppliers follow instructions in section 30.1; Part A providers billing Part B ambulance services follow instructions in section 30.2.

Beginning with dates of service on and after January 1, 2011:

• For trips totaling up to 100 covered miles, suppliers must round the total miles up to the nearest tenth of a mile and report the resulting number with the appropriate HCPCS code for ambulance mileage. The decimal must be used in the appropriate place (e.g., 99.9).
• For trips totaling 100 covered miles and greater, suppliers must report mileage rounded up to the next whole number mile without the use of a decimal (e.g., 998.5 miles should be reported as 999).
• For trips totaling less than 1 mile, enter a “0” before the decimal (e.g., 0.9).
• For mileage HCPCS billed on the ASC X12 837 professional transaction or the CMS-1500 paper form only, contractors shall automatically default to “0.1” units when the total mileage units are missing. 

Reference 

• CMS IOM Pub 100-04 Medicare Claims Processing Manual, Chapter 15

There are several ways to capture, and document loaded ambulance mileage, including:

• Odometer reading
• Trip odometer readings
• Global Positioning System (GPS)
• Navigation computers
• Mapping programs (e.g., MapQuest)

These are all acceptable forms of documentation and must be kept in the patient’s record and made available to Medicare upon request.

Note: Documentation must include the name and address of the origin and destination in the trip report completed by the ambulance supplier.