Medical Transptation Conversion Current Billing s X0002 call, two patients, each patient National Modifier New Billing s A0427, advanced life suppt, emergency transpt, level 1 (ALS1- emergency) UN Two patients served A0429, basic life suppt, emergency transpt (BLS- emergency) UN Two patients served Instructions Billing f two patients applies to emergency transptation f calls, A0427+UN, A0429+UN, A0429+UN+UJ, A0429+UN+UJ should be used to bill f emergency medical transptation A0427 UN UJ Services provided at X0006 Emergency run A0429 UN UJ Services provided at No Crossover (s) Available X0008 Neonatal intensive care incubat A0225 ; neonatal transpt, base rate, emergency transpt, one way A0225 UJ Services provided at There is no national code f compressed air f a neonatal incubat. Since compressed air is used in conjunction with a neonatal incubat, this service is to be included with overall neonatal transpt. f calls, A0225 A0225+UJ should be used to bill f emergency medical transptation A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s New Billing s X0010 Ground ambulance waiting time over 15 minutes; each 15 minutes A0420 National Modifier Ambulance waiting time (ALS BLS), one-half (1/2) hour increments Instructions Medi-Cal will reimburse up to 90 minutes, three units, of waiting time in excess of the first 15 minutes. In cases where a recipient is a neonate, Medi-Cal will reimburse up to 8 hours, 16 units, in excess of the first 15 minutes f documented waiting time needed to stabilize pri to transpt. X0012 Compressed air f infant respirat A0225 ; neonatal transpt, base rate, emergency transpt, one way A0225 UJ Services provided at A0420 may be used to bill f either emergency There is no national code f compressed air f a neonatal incubat. Since compressed air is used in conjunction with a neonatal incubat, this service is to be included with overall neonatal transpt. f calls, A0225 A0225+UJ should be used to bill f emergency medical transptation X0014 X0016 Extra attendant RN/EMT first hour Extra attendant RN/EMT 2nd 3rd hour each A0424 A0424 Extra ambulance attendant, ground (ALS BLS) air (fixed rotary winged); (requires medical review) Extra ambulance attendant, ground (ALS BLS) air (fixed rotary winged); (requires medical review) A0424 may be used to bill f either emergency A0424 may be used to bill f either emergency A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s X0018 X0020 X0030 Extra attendant RN/EMT (each additional hour) Cost of I.V. fluids (invoice must be attached) Ambulance service, Basic Life Suppt (BLS) base rate, emergency transpt, one way (includes allowance f emergency run). National Modifier New Billing s A0424 Extra ambulance attendant, ground (ALS BLS) air (fixed rotary winged); (requires medical review) No Crossover (s) Available A0427, advanced life suppt, emergency transpt, level 1 (ALS1- emergency) A0429, basic life suppt, emergency transpt (BLS-emergency) A0427 UJ Services provided at Instructions A0424 may be used to bill f either emergency deactivated due to low utilization. f calls, A0427, A0429, A0427+UJ, A0429+UJ should be used to bill f emergency medical transptation A0429 UJ X0032 Nonemergency transptation, ambulance, base rate, one way A0426, advanced life suppt, transpt, level 1 (ALS1) A0428, basic life suppt, nonemergency transpt (BLS) A0426 UJ Services provided at f calls, A0426, A0428, A0426+UJ, A0428+UJ should be used to bill f medical transptation A0428 UJ A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s X0034 X0036 X0200 X0202 X0204 X0206 Ambulance service, (BLS), per mile, transpt, one way Ambulance service, oxygen, administration supplies, life sustaining situation call non-litter patient, 1 patient call non-litter patient, 2 patients, each patient call non-litter patient, 3 patients, each patient call non-litter patient, 4 me patients, each patient National Modifier New Billing s Instructions A0380 BLS mileage (per mile) A0380 A0390 may be used to bill f either emergency nonemergency services. A0390 ALS mileage (per mile) A0422 Ambulance (ALS BLS) oxygen oxygen supplies, life sustaining situation A0130 Non-emergency transptation: A0130 Non-emergency transptation: UN Two patients served A0130 Non-emergency transptation: UP Three patients served A0130 Non-emergency transptation: UQ Four patients served A0422 may be used to bill f either emergency A0130 should be used to bill f medical transptation A0130+UN should be used to bill f medical transptation A0130+UP should be used to bill f medical transptation A0130+UQ, +UR, +US should be used to bill f medical transptation UR Five patients served US Six me patients served A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s X0208 X0210 X0212 X0214 call non-litter patient, wheelchair use call litter patient call litter patient, attendant Waiting time over 15 minutes each 15 minutes (maximum of 90 minutes) National Modifier New Billing s No Crossover (s) Available T2005 Non-emergency transptation: stretcher van T2001 Non-emergency transptation; patient attendant/esct T2007 Transptation waiting time, air ambulance, vehicle, one-half (1/2) hour increments Instructions deactivated, as it is used to bill f a service that is included as part of the overall transptation service. T2005 should be used to bill f medical transptation T2001 should be used to bill f medical transptation Medi-Cal will reimburse up to 90 minutes, three units, of waiting time in excess of the first 15 minutes. Used without a modifier, this code is f wheelchair van litter van transptation X0216 Mileage one way per mile (mileage with patient on board) A0425 Ground mileage, per statute mile T2007 may be used to bill f either emergency This code is used f litter van transptation A0425 should be used to bill f medical transptation A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s X0218 Night call 7 p.m. to 7 a.m. National Modifier New Billing s A0130 Non-emergency transptation: Instructions f calls, UJ Services provided at T2005 Non-emergency transptation: stretcher van A0130+UJ T2005+UJ should be used to bill f medical transptation UJ Services provided at X0220 Oxygen per tank A0422 Ambulance (ALS BLS) oxygen oxygen supplies, life sustaining situation A0422 may be used to bill f either emergency X0222 Unlisted A0999 Unlisted ambulance service X0400 call, ambulance A0426 A0428, advanced life suppt, transpt, level 1 (ALS1), basic life suppt, non- emergency transpt (BLS) A0999 may be used to bill f either emergency All X04XX codes were used f patient transfer from acute care facility to levels A/B. Modifier is H + N. A TAR is not required f transptation from an A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s X0402 Ambulance mileage, one way per mile (mileage with patient on board) National Modifier New Billing s Instructions A0380 BLS mileage (per mile) Modifier is H + N. A0390 ALS mileage (per mile) A TAR is not required f transptation from an X0404 X0406 call, litter patient, litter van transptation call, non-litter patient, transptation T2005 A0130 Non-emergency transptation: stretcher van Non-emergency transptation: Modifier is H + N. A TAR is not required f transptation from an Modifier is H + N. A TAR is not required f transptation from an X0408 Wheelchair/ litter van mileage, one way per mile (mileage with patient on board) A0425 Ground mileage, per statute mile Modifier is H + N. A TAR is not required f transptation from an A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s X0410 X0412 X0414 Wheelchair use, wheelchair/ litter van Oxygen, per tank Attendant, wheelchair/ litter van transptation A0422 T2001 National Modifier New Billing s No Crossover (s) Available Ambulance (ALS BLS) oxygen oxygen supplies, life sustaining situation Non-emergency transptation; patient attendant/esct X0416 Unlisted A0999 Unlisted ambulance service X0504 Night call, 7 p.m. to 7 a.m. A0430 UJ A0431, conventional air services, transpt, one way (fixed wing) Services provided at, conventional air services, transpt, one way (rotary wing) Instructions deactivated, as it is used to bill f a service that is included as part of the overall transptation service. Modifier is H + N. A TAR is not required f transptation from an Modifier is H + N. A TAR is not required f transptation from an A0999 may be used to bill f either emergency f calls, A0430+UJ A0431+UJ may be used to bill f either emergency nonemergency services. UJ Services provided at A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s New Billing s X0506 Waiting time over 15 minutes, each 15 minutes T2007 TU National Modifier Transptation waiting time, air ambulance, vehicle, one-half (1/2) hour increments Special payment rate, overtime Instructions Medi-Cal will reimburse up to 90 minutes, three units, of waiting time in excess of the first 15 minutes. In cases where a recipient is a neonate, Medi-Cal will reimburse up to 3 hours, 6 units, in excess of the first 15 minutes f documented waiting time needed to stabilize pri to transpt. X0508 X0510 X0512 Federal excise tax f fixedwing aircraft over 6,000 pounds Oxygen per tank Neonatal intensive care incubat A0422 A0999 No Crossover (s) Available Ambulance (ALS BLS) oxygen oxygen supplies, life sustaining situation Unlisted ambulance service T2007+TU may be used to bill f either emergency nonemergency services. deactivated due to low utilization. A0422 may be used to bill f either emergency A0999 may be used to bill f either emergency X0514 Compressed air f infant respirat A0999 Unlisted ambulance service A0999 may be used to bill f either emergency A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f
Medical Transptation Conversion (continued) Current Billing s New Billing s National Modifier Instructions X0516 Admin. I.V. Sol., 1000cc, incl. tubing other supplies No Crossover (s) Available deactivated, as it is used to bill f a service that is considered included as part of a bundled service should not be billed separately. X0518 Admin. I.V. Sol., 500cc, incl. tubing other supplies No Crossover (s) Available deactivated, as it is used to bill f a service that is considered included as part of a bundled service should not be billed separately. X0522 Unlisted air transptation (invoice must be attached) A0999 Unlisted ambulance service A0999 may be used to bill f either emergency A Treatment Authization Request (TAR) is required f the reimbursement of any services provided. claim fm by including condition code 81 (emergency indicat) on the UB-04 claim fm. Providers may refer to the Medical Transptation Ground Medical Transptation Air sections in the appropriate Part 2 manual f