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January 26, 2001

Dear Ambulance Supplier,

This letter contains important information regarding billing and reimbursement for ambulance services provided on or after January 1, 2001. Although implementation of the ambulance fee schedule has been delayed, there are several changes related to the fee schedule process that have not been delayed. This letter describes those changes that were implemented for services provided as of January 1, 2001.

Details regarding the transition to and implementation of the ambulance fee schedule can be found on the Health Care Financing Administration’s (HCFA) web site http://cms.hhs.gov/ (refer to transmittal AB-00-88 and AB-00-118). Additionally, the brochure that was distributed at the New Jersey seminars is available on our web site at http://www.empiremedicare.com/brochure/bro.htm.

There are six categories of ground ambulance services and two categories of air ambulance service that are effective as of January 1, 2001.

1. Basic Life Support (BLS) - When medically necessary, the provision of BLS services as defined in the National EMS Education and Practice Blueprint for the EMT- Basic, including the establishment of a peripheral intravenous (IV) line.
2. Basic Life Support (BLS) - Emergency -When medically necessary, the provision of BLS services, as specified above, in the context of an emergency response. An emergency response is one that, at the time the ambulance supplier is called, is provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the beneficiary’s health in serious jeopardy; in impairment to bodily functions; or in serious dysfunction to any bodily organ or part.
3. Advanced Life Support, Level 1 (ALS1) - When medically necessary, the provision of an assessment by an advanced life support (ALS) provider or supplier or the provision of one or more ALS interventions. An ALS provider/supplier is defined as a provider trained to the level of the EMT-Intermediate or Paramedic as defined in the National EMS Education and Practice Blueprint. An ALS intervention is defined as procedure beyond the scope of an EMT-Basic as defined in the National EMS Education and Practice Blueprint.
4. Advanced Life Support, Level 1 (ALS1) - Emergency - When medically necessary, the provision of ALS1 services, as specified above, in the context of an emergency response. An emergency response is one that, at the time the ambulance supplier is called, is provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the beneficiary’s health in serious jeopardy; in impairment to bodily functions; or in serious dysfunction to any bodily organ or part.
5. Advanced Life Support, Level 2 (ALS2) - When medically necessary, the administration of three or more different medications and the provision of at least one of the following ALS procedures:

• Manual defibrillation/cardioversion
• Endotracheal intubation
• Central venous line
• Cardiac pacing
• Chest decompression
• Surgical airway
• Intraosseous line

6. Specialty Care Transport (SCT) - When medically necessary, for a critically injured or ill beneficiary, a level of inter-facility service provided beyond the scope of the paramedic as defined in the National EMS Education and Practice Blueprint. This is necessary when a beneficiary’s condition requires ongoing care that must be provided by one or more health professionals in an appropriate specialty area, e.g., nursing, medicine respiratory care, cardiovascular care, or a paramedic with additional training.

Note: The existing requirements for the contractual agreements to provide inter-facility ALS transports remain in effect for services rendered on or after January 1, 2001.

1. Fixed Wing Air Ambulance (FW) - Fixed wing air ambulance is furnished when the beneficiary's medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by fixed wing air ambulance may be necessary because the beneficiary's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, e.g., heavy traffic, preclude such rapid delivery to the nearest appropriate facility. Transport by fixed wing air ambulance may also be necessary because the beneficiary is inaccessible by a land or water ambulance vehicle.
2. Rotary Wing Air Ambulance (RW) - Rotary wing air ambulance is furnished when the beneficiary’s medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by rotary wing air ambulance may be necessary because the beneficiary's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, e.g., heavy traffic, preclude such rapid delivery to the nearest appropriate facility. Transport by rotary wing air ambulance may also be necessary because the beneficiary is inaccessible by a land or water ambulance vehicle.

Changes effective for dates of service on or after January 1, 2001

1. Zip code of the point of pickup must be reported with the claim. Claims submitted with incomplete or invalid zip codes will be rejected. The zip code should be reported as follows:

• HCFA-1500 Claim form – report the 5 digit zip code in Item 23
• HCFA-1491 Claim form – report the 5 digit zip code in Item 12
• EDI submission – report as follows:

2. New ground transport codes are valid. The following table lists the new ground transport codes with the crosswalk from the old ground transport codes. The old codes marked as deleted codes are deleted effective for dates of service on or after January 1, 2001. There will be no grace period for the deleted codes.

New Code	Description of New Code	Method 1 Deleted Code	Method 2 Deleted Code	Method 3 Deleted Code	Method 4 Deleted Code
A0426	ALS1, Non-emergency w/ spec service	A0306	A0326	A0346	A0366
A0427	ALS1, emergency w/ spec service	A0310	A0330	A0350	A0370
A0428	BLS, Non-emergency	A0300	A0320	A0340	A0360
A0429	BLS, emergency land	A0302	A0322	A0342	A0362
A0429	BLS, emergency water	A0050	A0050	A0050	A0050
A0433	ALS2	A0310	A0330	A0350	A0370
A0434	SCT	A0310	A0330	A0350	A0370

 

3. New air transport codes are valid. The following table lists the new air transport codes. The old codes marked as deleted codes are deleted effective for dates of service on or after January 1, 2001. There will be no grace period for the deleted codes. Claims submitted for air ambulance services will continue to be priced on an individual consideration basis.

New Code	Description of New Code	Deleted Code (Any Billing Method)
A0430	Air Ambulance – Fixed Wing	A0030
A0435	Air mileage – Fixed Wing – per mile	N/A
A0431	Air Ambulance – Rotary Wing	A0040
A0436	Air mileage – Rotary Wing – per mile	N/A

4. The local code for cardiac monitoring during an ambulance trip (code Z0224) is deleted effective January 1, 2001 for dates of service on or after January 1, 2001. The reimbursement rate for this service has been added into the reimbursement rates for the ALS transport services with which they are performed. When cardiac monitoring is performed during an ALS transport, the billed amount for the transport should reflect the cardiac monitoring. Services submitted with code Z0224 will be rejected.
5. Codes that described situations where an ALS vehicle was used to provide a BLS level of service are deleted effective January 1, 2001. The following codes refer to situations where an ALS vehicle is used to provide a BLS level of service. For dates of service prior to January 1, 2001, these services were not billable to Medicare Part B for the state of New Jersey. These codes are deleted effective January 1, 2001 for dates of service on or after January 1, 2001. Until further notice, these services should be submitted with new code A0426 or A0427.

A0304	A0308	A0324	A0328	A0344
A0348	A0364	A0368

6. Until further notice, the new ground mileage code A0425 is not valid and should not be reported. Suppliers using billing method 2 or 4 should continue to bill the old ground mileage codes A0380 (BLS mileage, per mile) and A0390 (ALS mileage, per mile).
7. The following codes remain valid for dates of service on or after January 1, 2001. Suppliers using billing method 3 or 4 may continue to bill these codes during the transition to the fee schedule:

* =service denied as bundled

Since the transition to the fee schedule has been delayed, the allowance for ambulance services will be based on 100% of the reasonable charge amounts from the year 2000 increased by the ambulance inflation factor (AIF) of 2.7%. The attached fee schedules display the prevailing 75th and 50th percentile amounts as well as the IIC for each New Jersey locality. The Medicare allowance is the lowest of: 1) the submitted charge, 2) customary amount, 3) prevailing 75th or prevailing IIC. (Note: if a customary amount is not applicable, then item 2 is substituted with the prevailing 50th percentile.)

A separate fee schedule for each locality is attached to this letter. To determine the reimbursement rates effective for services rendered on or after January 1, 2001, refer to the attachment that lists the appropriate locality and the chart that lists the appropriate billing method.

To request information regarding your customary charge history, write to the Freedom of Information Act (FOIA) department at, P.O. Box 69209, Harrisburg, PA 17106-9209. If you have questions regarding this letter, contact a customer service representative at (877) 567-9235.

Sincerely,

Juliann Schell,

Provider Reimbursement

Attachments

Billing Method 2