evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Providers m ust report revenue code 054X and, for services  provided before January 1, 2001, one of the followi ng CMS HCPCS codes for each am bulance trip pr ovided duri ng the billing period:   A0030 (discontinued 12/31/2000); A0040 (discontinued 12/31/2000);  A0050 (discontinued 12/31/2000); A0320 (discontinued 12/31/2000); A0322 (discontinued 12/31/2000); A0324 (discontinued 12/31/2000); A0326 (discontinued 12/31/2000); A0328, (discontinued 12/31/2000); or A0330 (discontinued 12/31/2000).   In addition, providers report one of A0380 or A0390 for m ileage HCPCS codes.  No other HCPCS codes are acceptable for rep orting a mbulance ser vices and m ileage.  Providers report one of the following revenue codes:  0540;  0542;  0543;  0545;  0546; or  0548.  Do not report revenue codes 0541, 0544, or 0547.   For claims with  dates of service on or after January 1, 2001, providers must report revenue code 540 and one of the following HCPCS codes for each a mbulance trip provided during the billing period:   A0426; A0427; A0428; A0429; A0430; A0431; A0432; A0433; or A0434.   Providers using an ALS vehicle to furnish a BLS level of service report H CPCS code, A0426 (ALS1) or A0427 (ALS1 e mergen cy), and are paid accordingly.  In addition, all providers  report one of the following m ileage HCPCS codes:  A0380; A0390; A0435; or A0436.
(Medicare Claims Processing Manual)
Since billing  requi rements do not all ow for more than one HCPCS code to be repor ted for per revenue code line, providers m ust report revenue code 0540 (a mbulance) on two separate and consecutive lines to accom modate both the Part B a mbulance service and the m ileage HCPCS codes for each ambulance trip provided during t he billing period.  Each loaded (e.g., a patient is onboard) 1- way ambulance trip m ust be reported with a unique pair of revenue code lines on the  claim.  Unloaded trips and m ileage are NOT reported.  However, in the case where the beneficiar y was pronounced dead after the a mbulance is called/dispatched but before the a mbulance arri ves at t he scene:  Pay ment may be m ade for a BLS service if a ground vehicle is dispatched or at the fixed wing or rotary wing base rate, as applicable, if an air am bulance is di spatched.  Neither m ileage nor a rural adjust ment would be paid.  The ble nded rate amount w ill otherwise ap ply. Providers or suppliers report the A0428 (BLS) non -emergency or A0429 (BLS) emergency transport HCPCS c ode if an emergency response and m odifier QL (Patient pronounced dead after a mbulance called) in HCPCS/Rates instead of the ori gin and destination modifier for ground vehicles.  In addition to the QL  modifier, institutional- based providers repo rt modifier QM or QN.  If the time of death pronouncement is after takeoff to point of pickup but before the beneficiary is loaded on- board the air ambulance, air ambulance providers or suppliers bill the A0430 or A0431 depending on the type of aircraft and modifier QL.
(Medicare Claims Processing Manual)
If the ambulance is called/dispatched but the beneficiary dies on the scene prior to the arrival of the ambulance: Payment may be made for BLS service if a ground vehicle is dispatched or at the fixed wing or rotary wing base rate, as applicable, if an air  ambulance is di spatched.  Neither m ileage nor a rural adjust ment would be paid. Providers or suppliers report the A0428 (BLS) non -emergency or A0429 (BLS) emergency transport HCPCS c ode if an emergency response and modifier QL for ground vehicles.  Air am bulance providers or suppliers bill the A0430 or A0431 depending on the type of aircraft and modifier QL, if the time of death pronouncement is after takeoff to point of pickup but before the beneficiary is loaded on- board the air ambulance.   If the beneficiary dies after the ambulance is dispatched but before the beneficiary is loaded onboard the ambulance (before or after arrival at the point -of-pickup): Medicare payment determination is providers or suppliers BLS base rate, no mileage or rural adjustment; providers or suppliers report the A0428 (BLS) non- emergency or A0429 (BLS) emergency transport HCPCS code if an emergency response and modifier QL. However, if the beneficiary dies after pickup, prior to or upon arrival at the receiving fa cility: Medically necessary level of service furnished will be the payment determination.    NOTE:  Infor mation regarding the claim  form locator that corresponds to the HCPCS code is found in Pub. 100- 04, Medicare Claims Processing Manual,  Chapter 25 - Completing and Processing the Form CMS -1450 Data Se t.  E. Modifier Reporting   See the above Section 30 (A)  (Modifiers Specific to A mbulance Service Claims)  for instructions regarding the usage of m odifier s.  F. Line -Item Dates of Service Rep orting
(Medicare Claims Processing Manual)
E. Modifier Reporting   See the above Section 30 (A)  (Modifiers Specific to A mbulance Service Claims)  for instructions regarding the usage of m odifier s.  F. Line -Item Dates of Service Rep orting   Providers are required to report  line-item dates of service per revenue code line.  This m eans that they m ust report two separate revenue code lines for every ambulance trip provided d uring the billing period along with the date of each trip.  T his includes situations in which m ore than one a mbulance  service is provided to the sa me beneficiary on the sam e day.  Line -item dates of servi ce are reported in t he Servi ce Date f ield.  NOTE:   Infor mation regarding the claim  form locator that corresponds to the Service Date is found i n Pub. 100- 04, Medicare Claims Processing Manual,  Chapter 25 -  Completing and Processing the Form CMS -1450 Data Se t.  G. Servi ce Units Reporting   For line ite ms reflecting HCPCS code A0030, A0040, A0050, A0320, A0322, A0324, A0326, A0328, or A0330 (services before January 1, 2001) or code A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434 (services on and after January 1, 2001), providers are required to report  in Service Units each am bulance trip provided during the billing per iod.  Therefore, the service u nits for each occurrence of these HCPCS codes are always equal to one.  In addition, for line ite ms reflecting HCPCS code A0380 or A0390, the nu mber of loaded m iles must be reported.  (See exa mples below.)   Therefore, the service units for each  occur rence of these HCPCS codes are always equal to one.  In addition, for line ite ms reflecting HCPCS code A0380, A0390, A0435, or A0436, the num ber of loaded m iles must be reported.   H. Total Charges Reporting
(Medicare Claims Processing Manual)
H. Total Charges Reporting  For line ite ms reflecting HCPCS codes A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434;   Providers are required to repor t in T otal Char ges the actual charge for the a mbulance servi ce including all su pplies u sed for the a mbulance trip but excluding the charge for m ileage. For line items reflecting H CPCS code A0380, A0390, A0435, or A0436, report the actual c harge for mileage.   NOTE:   There are instances where the provider does not incur  any cost for m ileage, e.g., if the beneficiary is pron ounced dead after the ambulance is called b ut before the am bulance arrives at the scene.   In these situations, providers report the base rate a mbulance trip and m ileage as separate revenue code  lines.   Providers  report the base rate am bulance trip in accor dance with current bi lling require ments.  For purposes of reporting m ileage, they must report the appropr iate HCPCS c ode, m odifi ers, and units as a separate line item .  For the related  charges, providers report $1.00 in FL48 for non - covered charges.  A/B MACs (A) should assign remittance adjustment Group Code OA to the $1.00 non-  covered m ileage line, which in turn infor ms the beneficiaries  and providers that they each have no liability.  Prior to su bmitting the c laim to CWF, the A/B MAC (A) will re move the entire reve nue code line containing the m ileage amount repo rted in Non- covered Charges to avoid non- acceptance of the clai m.  NOTE:   Infor mation regarding the claim  form locator that corresponds to the Charges fields is found in Pub. 100- 04, Medicare Claims Processing Manual,  Chapter 25 - Completing and Processing the Form CMS -1450 Data Se t.
(Medicare Claims Processing Manual)
NOTE:   Infor mation regarding the claim  form locator that corresponds to the Charges fields is found in Pub. 100- 04, Medicare Claims Processing Manual,  Chapter 25 - Completing and Processing the Form CMS -1450 Data Se t.  EXAM PLES:  The f ollowing provi des exam ples of  how bills f or Part B ambulance services should be com pleted based on t he reporting require ments above.  These exam ples reflect ambulance ser vices fur nished directly by providers.  Ambulance services provided under arrangem ent between  the provider and an a mbulance co mpany are reported in the sam e manner except provid ers report  a QM modifier instead of a QN modifier.   EXAM PLE 1: Claim containing only one a mbulance trip:   Providers report as follows:   Revenue Code  HCPCS/ Modifiers  Date of Service  Units  Total Charges  0540  A0428RHQN  082701  1 (trip)  100.00  0540  A0380RHQN  082701  4 (mileage)  8.00  EXAMPLE 2:  Claim contai ning multi ple am bulance tri ps:  Providers report as follows:   Revenue Code  HCPCS  Modifiers  Date of Service  Units  Total Charges  #1 #2 0540  A0429  RH QN 082801  1 (trip)  100.00  0540  A0380  RH QN 082801  2 (mileage)  4.00 0540  A0330  RH QN 082901  1 (trip)  400.00  0540  A0390  RH QN 082901  3 (mileage)  6.00  EXAM PLE 3: Claim contai ning m ore than o ne ambulance trip provided on the sa me day:   Providers report as follows:   Revenue Code  HCPCS  Modifiers  Date of Service  Units  Total Charges  0540  A0429  RH QN 090201  1 (trip)  100.00  0540  A0380  RH QN 090201  2 (mileage)  4.00 0540  A0429  HR QN 090201  1 (trip)  100.00  0540  A0380  HR QN 090201  2 (mileage)  4.00  I. Edits   FISS edits to assure proper reporting as follows:
(Medicare Claims Processing Manual)
I. Edits   FISS edits to assure proper reporting as follows:    For clai ms with dates of  service on or  after Jan uary 1, 2001, each pair of revenue codes 0540 must have one of the following a mbulance HCPCS codes -  A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434; and one of the following mileage HCPCS codes -  A0435, A 0436 or for clai ms with dates of service on or after April 1, 2002, A0425;    For clai ms with dates of service on or  after January 1, 2001, t he presence of an origin and destination m odifier and a  QM or QN modifier for every line item containing revenue code 0540;    The units field is co mpleted for every line item  containing revenue code 0540;    For clai ms with dates of service on or  after January 1, 2001, the units field is completed for every line item  containing revenue code 0540;    Service units for line ite ms containing HCPCS codes A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434 always equal 1"   For clai ms with dates of service on or a fter July 1, 2001, each 1- way ambulance trip, line - item dates of  service for the a mbulance ser vice, a nd corresp onding m ileage are eq ual.    30.2.1 - A/B MAC (A) Bill Processing Guidelines Effective April 1, 2002, as a Result of Fee Schedule Implementation  (Rev. 3076, Issued: 09- 24-14, Effective: Upon Implementation of ICD -10 ASC X12: 01- 01-12, Implementation: ICD -10: Upon Implementation of ICD -10 ASC X12: 09- 16-14)
(Medicare Claims Processing Manual)
For SNF Part A, the cost of medically necessary ambulance transportation to receive most services included in the RUG rate is included in the cost for the service. Payment for the SNF claim is based on the RUGs, which takes into account the cost of such tr ansportation to receive the ancillary services.   Refer to IOM Pub. 100- 04, Medicare Claims Processing Manual, chapter 6 -  SNF Inpatient Part A Billing, Section 20.3.1 -  Ambulance Services for additional information on SNF consolidated billing and ambulance transportation.  Refer to IOM Pub. 100- 04, Medicare Claims Processing Manual, chapter 3 -  Inpatient Hospital Billing, section 10.5 -  Hospital Inpatient Bundling, for additional information on hospital inpatient bundling of ambulance services.   In general, the A/B MAC (A) processes claims for Part B ambulance services provided by an ambulance supplier under arrangements with hospitals or SNFs.  These providers bill A/B MACs (A) using only Method 2.  The provider must furnish the following data in accordance with A/B MAC (A) instructions.  The A/B MAC (A) will make arrangements for the method and media for submitting the data:    A detailed statement of the condition necessitating the ambulance service;    A statement indicating whether the patient was admitted as an inpatient.  If yes the name and address of the facility must be shown;    Name and address of certifying physician;    Name and address of physician ordering service if other than certifying physician;    Point of pickup (identify place and completed address);    Destination (identify place and complete address);    Number of loaded miles (the number of miles traveled when the beneficiary was in the ambulance);    Cost per mile;   Mileage charge;    Minimum or base charge; and   Charge for special items or services.  Explain.   A. Revenue Code Reporting on Form CMS -1450  Providers report ambulance services under revenue code 540 in FL 42 Revenue Code.   B. HCPCS Codes Reporting on Form CMS -1450  Providers report the HCPCS codes established for the ambulance fee schedule.  No other HCPCS codes are acceptable for the reporting of ambulance services and mileage.  The HCPCS code must be used to reflect the type of service the beneficiary received, not  the type of vehicle used.
(Medicare Claims Processing Manual)
Providers must report one of the following HCPCS codes in FL 44 HCPCS/Rates for each base rate ambulance trip provided during the billing period:   A0426;  A0427;  A0428;  A0429;  A0430;  A0431;  A0432;  A0433; or  A0434.  These are the same codes required effective for services January 1, 2001.   In addition, providers must report one  of HCPCS mileage codes:   A0425;  A0435; or  A0436.  Since billing requirements do not allow for more than one HCPCS code to be reported per revenue code line, providers must report revenue code 540 (ambulance) on two separate and consecutive line items to accommodate both the ambulance service and the mileage HCPCS codes for each ambulance trip provided during the billing period.  Each loaded (e.g., a patient is onboard) 1- way ambulance trip must be reported with a unique pair of r evenue code lines on the claim.  Unloaded trips and mileage are NOT  reported.  For Form CMS -1450 claims submission prior to August 1, 2011, providers code one mile for trips less than a mile.  Miles must be entered as whole numbers.  If a trip has a fraction of a mile, round up to the nearest whole number.   Beginning with dates of service on or after January 1, 2011, for Form CMS -1450 hard copy claims submissions August 1, 2011 and after, mileage must be reported as fractional units.  When reporting fractional mileage, providers must round the total miles up to the nearest tenth of a mile and the decimal must be used in the appropriate place (e.g., 99.9).   For trips totaling less than 1 mile, enter a 0 before the decimal (e.g., 0.9).   For electronic claims submissions prior to January 1, 2011, providers code one mile for trips less than a mile.  Miles must be entered as whole numbers.  If a trip has a fraction of a mile, round up to the nearest whole number.
(Medicare Claims Processing Manual)
For electronic claims submissions prior to January 1, 2011, providers code one mile for trips less than a mile.  Miles must be entered as whole numbers.  If a trip has a fraction of a mile, round up to the nearest whole number.   Beginning with dates of service on or after January 1, 2011, for electronic claim submissions only, mileage must be reported as fractional units for trips totaling up to 100 covered miles.  When reporting fractional mileage, providers must round the total miles up to the nearest tenth of a mile and the decimal must be used in the appropriate place (e.g., 99.9).   For trips totaling 100 covered miles and greater, providers must report mileage rounded up to the nearest whole number mile (e.g., 999) and not use a decimal when reporting whole number miles over 100 miles.   For trips totaling less than 1 mile, enter a 0 before the decimal (e.g., 0.9).   C. Modifier Reporting   Providers must report an origin and destination modifier for each ambulance trip provided and either a QM (Ambulance service provided under arrangement by a provider of services) or QN (Ambulance service furnished directly by a provider of services) modifi er in FL 44 HCPCS/Rates".   D. Service Units Reporting   For line items reflecting HCPCS codes  A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434, providers are required to report in Service Units for each ambulance trip provided.  Therefore, the service units for each occurrence of these HCPCS codes are always equal to one. In addition, for line items reflecting HCPCS code  A0425, A0435, or  A0436, providers must also report the number of loaded miles.  E. Total Charges Reporting  For line items reflecting HCPCS codes  A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434, providers are required to report in Total Charges the actual charge for the ambulance service including all supplies used for the ambulance trip, but excluding the charge for mileage.
(Medicare Claims Processing Manual)
For line items reflecting HCPCS codes  A0425, A0435, or A0436, providers are to report the actual charge for mileage.   NOTE :  There are instances where the provider does not incur any cost for mileage, e.g., if the beneficiary is pronounced dead after the ambulance is called but before the ambulance arrives at the scene.  In these situations, providers report the base rate ambulance trip and mileage as separate revenue code lines.  Providers report the base rate ambulance trip in accordance with current billing requirements.  For purposes of reporting mileage, they must report the a ppropriate HCPCS code, modifiers, and units.  For the related charges, providers report $1.00 in non-covered charges.  A/B MACs (A) should assign remittance adjustment Group Code OA to the $1.00 non- covered mileage line, which in turn informs the beneficia ries and providers that they each have no liability.   F. Edits (A/B MAC (A) Claims with Dates of Service On or After 4/1/02)   For claims with dates of service on or after April 1, 2002, FISS performs the following edits to assure proper reporting:    Edit to assure each pair of revenue codes 540 have one of the following ambulance HCPCS codes -  A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434; and one of the following mileage HCPCS codes -  A0425, A0435, or A0436.    Edit to assure the presence of an origin, destination modifier, and a QM or QN modifier for every line item containing revenue code 540;    Edit to assure that the units field is completed for every line item containing revenue code 540;    Edit to assure that service units for line items containing HCPCS codes A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, or A0434 always equal 1"; and
(Medicare Claims Processing Manual)
 Edit to assure on every claim that revenue code 540, a value code of A0 (zero), and a corresponding ZIP Code are reported. If the ZIP Code is not a valid ZIP Code in accordance with the USPS assigned ZIP Codes, A/B MACs (A) verify the ZIP Code to determine  if the ZIP Code is a coding error on the claim or a new ZIP Code from the USPS not on the CMS supplied ZIP Code File.    Beginning with dates of service on or after April 1, 2012, edit to assure that only non-emergency trips (i.e., HCPCS A0426, A0428 [when A0428 is billed without modifier QL]) require an NPI in the Attending Physician field.  Emergency trips do not require an NPI in the Attending Physician field (i.e., A0427, A0429, A0430, A0431, A0432, A0433, A0434 and A0428 [when A0428 is billed with modifier QL])   G. CWF (A/B MACs (A))   A/B MACs (A) report the procedure codes in the financial data section.  They include revenue code, HCPCS code, units, and covered charges in the record.  Where more than one HCPCS code procedure is applicable to a single revenue code, the provider reports each HCPCS code and related charge on a separate line, and the A/B MAC (A) reports this to CWF.  Report the payment amount before adjustment for beneficiary liability in Rate and the actual charge in Covered Charges.   30.2.2 - SNF Billing (Rev.4021; Issued: 04- 13-18; Effective: 07 -16-18; Implementation: 07 -16-18)
(Medicare Claims Processing Manual)
30.2.2 - SNF Billing (Rev.4021; Issued: 04- 13-18; Effective: 07 -16-18; Implementation: 07 -16-18)  When billing for ambulance transports of SNF residents, suppliers should indicate whether the transport was part of a SNF Part A covered stay, using the appropriate origin/destination modifier (e.g., NH for a transport from a SNF to a hospital). The following ambulance transportat ion and related ambulance services for residents in Part A stays are not included in the PPS rate.  For additional information, see Chapter 6, SNF Inpatient Part A Billing and SNF Consolidated Billing,  20.3.1, Ambulance Services.  They may be billed as P art B services by the supplier only in the following situations:   The ambulance trip is to the SNF for admission (the second character (destination) of any ambulance HCPCS code modifier is N (SNF) other than modifier QN, and the date of service is the same as the SNF 21X admission date.)
(Medicare Claims Processing Manual)
 The ambulance trip is from the SNF to home (the first character (origin) of any HCPCS code ambulance modifier is N (SNF)), and date of ambulance service is the same date as the SNF through date, and the SNF patient status (FL 22) is other than 30.)   The ambulance trip is to or from a hospital based or non- hospital based ESRD facility (either one of any HCPCS code ambulance modifiers is G (Hospital based dialysis facility) or J (Non -hospital based dialysis facility) and the other modifier is N (SNF)).   The ambulance trip is from the SNF to another SNF (the first and second character (origin and destination) of any ambulance HCPCS code modifier is N (SNF)) and the beneficiary is not in a Part A stay.  Ambulance payment associated with the following outpatient hospital service exclusions is paid under the ambulance fee schedule:   Cardiac catheterization;   Computerized axial tomography (CT) scans;   Magnetic resonance imaging (MRIs);   Ambulatory surgery involving the use of an operating room, including the insertion, removal, or replacement of a percutaneous esophageal gastrostomy (PEG) tube in the hospitals gastrointestinal (GI) or endoscopy suite;   Emergency services;   Angiography;   Lymphatic and Venous Procedures; and   Radiation therapy.  See  Chapter 6,  20.1.2, Other Excluded Services Beyond the Scope of a SNF Part A Benefit, for further information pertaining to the list of services that are excluded from SNF Part A payment referenced above.  The following ambulance transportation and related ambulance services for residents in a Part A stay are included in the SNF PPS rate and may not  be billed as Part B services by the supplier.  For additional information, see Chapter 6,  20.3.1, In these scenarios, the services provided are subject to SNF CB and the first SNF is responsible for billing the services to the A/B MAC (A):   Suppliers should bill with an NN origin/destination modifier when a SNF -to-SNF transport occurs.  A transport between two SNFs (that is,
(Medicare Claims Processing Manual)
to the A/B MAC (A):   Suppliers should bill with an NN origin/destination modifier when a SNF -to-SNF transport occurs.  A transport between two SNFs (that is, a beneficiarys same -day transfer from one SNF to another) is not separately payable when a beneficiary is in a Part A covered SNF stay, and will result in a denial of a Part B claim for such a transport.