Ambulance Billing
Ambulance services provided to Total Health Care members, must be reported with the appropriate ambulance HCPCS code, and correct origin and destination modifiers or the service will be denied. Modifiers identifying place of origin and destination of the ambulance trip must be submitted on all ambulance claims. The modifier is to be placed next to the Health Care Procedure Coding System (HCPCS) code billed. For more information regarding valid ambulance procedure codes, please refer to the Ambulance Procedure Codes article.
Each of the modifiers may be utilized to make up the first and/or second half of a two letter modifier. The first letter must describe the origin of the transport, and the second letter must describe the destination (Example: if a patient is picked up at his/her home and transported to the hospital, the modifier to describe the origin and destination would be – RH).
Origin and Destination Modifiers
For ambulance transportation claims, United Healthcare Community Plan has adopted the Centers for Medicare and Medicaid Services (CMS) guidelines that require an Ambulance Supplier to report an origin and destination modifier for each trip provided.
State Exceptions
Missouri – Per State Regulations, codes A0394, A0398, A0422 and 93040 are separately payable when billed with HCPCS codes A0430, A0431, A0435 or A0436 for Missouri Medicaid. Missouri Medicaid has a state specific list of origin and destination modifiers that are included in this policy. See list in Attachments Section: Missouri Medicaid Ambulance Modifiers Missouri is exempt from the ESRD reduction.
Ohio – Ohio Medicaid has a state specific list of origin and destination modifiers that are included in this policy. See list in Attachments Section: Ohio Ambulance Modifiers Ohio is exempt from the ESRD reduction.
Wisconsin – Per State Regulations, codes A0382, A0384, A0392, A0394, A0396, A0398, A0422, and A0424 are separately payable for Wisconsin Medicaid. Wisconsin is exempt from the ESRD reduction. Per State Regulations, Wisconsin requires claims for ambulance services to include origin and destinations modifiers, as well as trip modifiers (U1-U6).
BILLING INSTRUCTIONS FOR HOSPITAL-OWNED AMBULANCES
The appropriate origin and destination modifier(s) must be included on the service line when billing for mileage.
When a beneficiary requires more than one ambulance transport on the same date of service, providers must report:
the appropriate origin and destination modifier with both the base rate and the mileage procedure codes;
ORIGIN AND DESTINATION MODIFIERS
When billing for ambulance services, appropriate origin and destination modifiers must be included on any service line when billing for mileage. The first character of the modifier is the origin code and the second character of the modifier is the destination code (e.g., use modifier RH for a transport from the residence to the hospital).
Mileage reimbursement is a Medicaid benefit when:
A transport occurs.
Loaded mileage is billed.
Appropriate origin and destination modifier combinations are utilized
Refer to the Billing & Reimbursement for Professionals or the Billing & Reimbursement for Institutional Providers chapters of this manual, as appropriate, for a list of origin and destination modifiers. When billing for mileage greater than 100 miles, enter the origin and destination addresses in the Remarks section.
For ambulance service claims, institutional-based providers and suppliers must report origin and destination codes for each ambulance trip provided in HCPCS/Rates. Origin and destination codes used for ambulance services are created by combining two alpha characters. Each alpha character, with the exception of “X”, represents an origin code or a destination code. The pair of alpha codes creates one code to be reported in modifier field. The first position alpha code equals origin; the second position alpha code equals destination. The Centers for Medicare & Medicaid Services (CMS) maintains the list of valid codes.
Origin and destination codes and their descriptions are as follows:
D = Diagnostic or therapeutic site other than P or H when these are used as origin codes;
E = Residential, domiciliary, custodial facility (other than 1819 facility);
G = Hospital based ESRD facility;
H = Hospital;
I = Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport;
J = Freestanding ESRD facility;
N = Skilled nursing facility;
P = Physician’s office;
R = Residence;
S = Scene of accident or acute event;
X = Intermediate stop at physician’s office on way to hospital (destination code only)
Providers will be required to use the following ambulance origin and destination modifiers: “D,” “E,” “G,” “H,” “I,” “J,” “N,” “P,” “R,” “S,” and “X.” These single letter modifiers are used in combination on the claim form to indicate the origin and destination of the ambulance trip. The first letter indicates the transport’s place of origin; the second letter indicates the destination. Use origin and destination modifiers on claims but not on PA requests Origin and destination codes and their descriptions are as follows:
D = Diagnostic or therapeutic site other than P or H when these are used as origin codes;
E = Residential, domiciliary, custodial facility (other than 1819 facility);
G = Hospital based ESRD facility;
H = Hospital;
I = Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport;
J = Freestanding ESRD facility;
N = Skilled nursing facility;
P = Physician’s office;
R = Residence;
S = Scene of accident or acute event;
X = Intermediate stop at physician’s office on way to hospital (destination code only)
Origin Codes
Origin codes in the context of ambulance service claims refer to the location from which the ambulance transport originates. These codes are essential for identifying where the patient was located at the time of ambulance dispatch. The Centers for Medicare & Medicaid Services (CMS) has established specific origin codes that are used to indicate the location of the patient at the time of pick-up. These codes are integral to accurately documenting the starting point of the ambulance transport and are vital for proper claim submission.
It’s important for ambulance service providers to correctly determine and document the origin code based on the location from which the ambulance transport commenced. This could include locations such as a private residence, a skilled nursing facility, an outpatient facility, or any other location from which the ambulance was dispatched to transport the patient. The accurate assignment of the origin code ensures that the billing and reimbursement process proceeds smoothly, minimizing the risk of claim denials or delays.
Destination Codes
On the other hand, destination codes pertain to the location to which the ambulance transport is destined. These codes indicate the specific facility or location where the patient is being transported, such as a hospital, a skilled nursing facility, a diagnostic facility, or any other designated healthcare facility. Similar to origin codes, destination codes are crucial for accurately documenting the endpoint of the ambulance transport and are vital for proper claim submission and reimbursement.
Correctly identifying and documenting the destination code is imperative for ambulance service providers, as it ensures that the appropriate facility or location where the patient is being transported is accurately recorded. This information is essential for billing and reimbursement purposes, as it provides clarity on the endpoint of the ambulance transport and the associated healthcare facility or destination. Accurate destination coding minimizes the likelihood of billing errors and facilitates efficient claims processing.