- Ambulance Billing Guide
- Ambulance Duplicate Claim Denials
- Ambulance Transports Included in SNF Consolidated Billing
- Ambulance Physician Certification Statement Guidelines
- Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport
- New York State Ambulance Services in Rural Areas (for JK providers only)
- Coverage of Rural Air Ambulance Services
- Ambulance Transports Excluded from SNF Consolidated Billing
- Ambulance Medical Necessity Reminder for ESRD Patients
- Related Content
- Related Articles
- Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10
- Ambulance Medical Necessity
- Ambulance Rural ZIP Code Search
- Billing for A0426 or A0428
- Medical Necessity of Ambulance Services
- Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports
- Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity
Ambulance Transports Included in SNF Consolidated Billing
| Transport Description | Medical Necessity Met | Ambulance Billing Modifiers and Other Considerations | Who is Responsible for Payment? | Reference(s) |
|---|---|---|---|---|
| SNF to SNF Note: The day of departure from SNF 1 is a covered Part A day (to which consolidated billing would apply) only if the beneficiary’s admission to SNF 2 occurs by midnight of the day of departure. |
YES | The first character (origin) of any HCPCS ambulance modifier is N (SNF), the second character (destination) of the HCPCS ambulance modifier is N (SNF) and the patient status is 03. An ambulance trip that is medically necessary to effect this type of SNF-to-SNF transfer would be bundled back to SNF 1, as in this specific situation the beneficiary would continue to be considered a “resident” of SNF 1 for CB purposes up until the actual point of admission to SNF 2. For example, a SNF-to-SNF transfer would be considered reasonable and necessary in a situation where needed care is unavailable at the originating SNF, thus necessitating a transfer to the receiving SNF in order to obtain that care. |
SNF 1-Transferring SNF | CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services |
| SNF to SNF Note: The day of departure from SNF 1 is a covered Part A day (to which consolidated billing would apply) only if the beneficiary’s admission to SNF 2 occurs by midnight of the day of departure. |
NO | The first character (origin) of any HCPCS ambulance modifier is N (SNF), the second character (destination) of the HCPCS ambulance modifier is N (SNF) and the patient status is 03. A SNF-to-SNF transfer that is prompted by non-medical considerations (such as a patient’s personal preference to be placed in the receiving SNF) is not considered reasonable and necessary for diagnosing or treating the patient’s condition and, thus, would not be bundled back to the originating SNF. |
Beneficiary | CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services |
| Ambulance transports to or from a diagnostic or therapeutic site other than a hospital or renal dialysis facility (e.g., an independent diagnostic testing facility (IDTF), cancer treatment center, radiation therapy center, wound care center, etc.) | YES | The ambulance transport is included in the SNF PPS rate if the first or second character (origin or destination) of any HCPCS code ambulance modifier is “D” (diagnostic or therapeutic site other than “P” or “H”), and the other modifier (origin or destination) is “N” (SNF). | SNF | CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services |
| SNF Part A resident to a physician’s office (round trip) | YES | First or second character (origin or destination) of any HCPCS code ambulance modifier is “P” (physician’s office), and the other modifier (origin or destination) is “N” (SNF) | SNF | CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services 42 CFR Section 409.27 (c ) Other services generally provided by (or under arrangements made by) SNFs 42 CFR Section 410.40 Coverage of ambulance services (d) |
| SNF Part A resident to a physician’s office (round trip) | NO | First or second character (origin or destination) of any HCPCS code ambulance modifier is “P” (physician’s office), and the other modifier (origin or destination) is “N” (SNF) Note: Medicare does not provide any coverage at all under Part A or Part B for any non-ambulance forms of transportation, such as ambulette, wheelchair van, or litter van. In order for the Part A SNF benefit to cover transportation via ambulance, the regulations at 42 CFR 409.27(c) specify that the ambulance transportation must be medically necessary--that is, the patient’s condition is such that transportation by any means other than ambulance would be medically contraindicated. | Beneficiary | CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services |
Reviewed 10/23/2023