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Ambulance Transports Excluded from SNF Consolidated Billing

When a Medicare beneficiary is a resident in a SNF under a Part A stay, not all ambulance transports are included in the PPS (prospective payment system) payment for a SNF. SNF consolidated billing includes those medically necessary ambulance trips that are furnished during the course of a covered Part A stay except for specific exclusions as indicated in the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section 20.3.1—Ambulance Services. (435 KB)

In most cases, ambulance trips are excluded from consolidated billing when resident status has ended. The ambulance company then must bill the MAC (as appropriate) directly for payment. Listed below are specific circumstances under which a beneficiary may receive ambulance services that are covered by Medicare, but excluded from consolidated billing. The following ambulance services may be billed as Part B services to Medicare by the ambulance provider/supplier in the following situations only.

Note: All ambulance transports billed to the MAC for Part B payment must meet medical necessity and CMS ambulance program requirements.

Transport Description Ambulance Billing Modifiers
Ambulance transport to a SNF for admission The second character (destination) of any ambulance HCPCS modifier is N (SNF) other than modifier QN, and the date of service is the same as the SNF 21X admission date.
The ambulance trip is from the SNF after discharge, to the beneficiary’s home The first character (origin) of any HCPCS ambulance modifier is N (SNF), the second character (destination) of the HCPCS ambulance modifier is R (Residence), and date of ambulance service is the same date as the SNF through date. * Note: this includes beneficiaries discharged home to receive services from a Medicare-participating home health agency under a plan of care
The ambulance trip is to a hospital based or nonhospital based ESRD facility for the purpose of receiving dialysis and related services excluded from consolidated billing The first character (origin) of the HCPCS ambulance modifier is N (SNF), and the second character (destination) HCPCS ambulance modifier code is G (Hospital-based dialysis facility) or J (Non-hospital based dialysis facility)) for the purpose of receiving dialysis and related services excluded from consolidated billing.
The ambulance trip is from the SNF to a Medicare-participating hospital or a CAH for an inpatient admission The first character (origin) of the HCPCS ambulance modifier is N (SNF), and the second character (destination) of the HCPCS modifier is H
The ambulance trip follows a formal discharge or other departure from the SNF to any destination other than another SNF, and the beneficiary does not return to that or any other SNF by midnight of that same day The first character (origin) of the HCPCS ambulance modifier is- N (SNF) and the second character (destination) of the HCPCS modifier is a Medicare covered destination.
An ambulance trip that conveys a beneficiary to a hospital or CAH and back to the SNF for the specific purpose of receiving emergency or other excluded services Ambulance origin modifier- N (SNF) of H (hospital)


Ambulance destination modifier- N(SNF) or H (hospital)
Ambulance Transports Excluded from SNF Consolidated Billing
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