Ambulance Duplicate Claim Denials

Duplicate trips may be reported on the same claim if the ZIP code for the point of pick-up for both trips is the same. If separate claims are submitted for the same beneficiary on the same day with the same ZIP code, and you bill them on separate claims, the second claim could deny as an exact duplicate.

Bill both transports together on the same claim to avoid this duplicate denial from occurring. You can also utilize the extra narrative field to indicate that two trips occurred on the same date and indicate the times of both transports so our claim processors will see the difference between the two. Documentation to support the medical necessity of the transports should always be maintained.

The 76 modifier may be appended to the second transport on the claim to reflect the repeated transportation after the original. We’ve included an example below to reflect how the duplicate transportations should be billed:

Example:
Two identical, round-trip transportations take place for the same beneficiary on the same date, same ZIP code with the same origin/destination modifiers. For this example, the transportation occurred from a residence (ambulance point-of-pick-up modifier “R”) to a hospital emergency room (ambulance destination modifier “H”).

• Submit the first round-trip ambulance transport claim with the appropriate HCPCS code based on the level of service provided, with RH on the first detail line and HCPCS code A0425 with RH to reflect the mileage, on the second detail line.
• Submit the second round-trip ambulance transport claim with the appropriate HCPCS code based on the level of service provided on the second trip, along with modifier RH and add the 76 modifier (e.g., A0426/RH/76) on the first detail line and HCPCS code A0425 with RH/76 to reflect the mileage on the second detail line.

Note: You should always submit the origin and destination modifiers in the first position and CPT modifier 76 in the second position on the claim.

Posted 2/26/2024