CMS - The Center for Medicaid and Medicare
Services
CMS is the federal agency
which administers Medicare, Medicaid, and the State Children's
Health Insurance Programs across the country. It is a
division of the Department of Health and Human Services.
They are the "starting" place for ambulance billing questions
and answers.
CMS approves insurance
carriers to handle Medicare Part A and Medicare Part B claims.
In most cases, a carrier will process claims on behalf of
several states and may provide Part-A, Part-B, or both. CMS monitors this process
and sets forth rules, guidelines, and approval criteria for
providers and claims. CMS publishes a
list of authorized carriers.
Medicare has two primary
components, Part-A and Part-B:
- Medicare Part-A
- Hospitals
- Nursing Homes
- Institutions
- Ambulances that are provided by a hospital as part of
their in-house services
- Their bills are part of the overall hospital billing
- Medicare Part B
- Physicians
- Independent labs
- Independent diagnostic facilities
- Most Ambulances
- Fire Departments
- Rescue Squads
- Privately owned ambulance companies
- CMS sets forth the following rules and
guidelines with respect to ambulance providers and ambulance
claims:
- Coverage of Ambulance Services
- Defines basic rules
- Definitions of types of service
- Medical necessity rules
-
42 CFR 410.10
- General Requirements for Ambulance Suppliers
- Ambulance Fee Schedule
- NPI Rule
- HIPAA final rule on National Provider Identifier
Numbers
-
45 CFR 162
- Medicare Ambulance Manual
- Medicare CMS 1500 Form Manual
- Medicare Benefit Policy Manual for Ambulance Services
- CMS Procedure (HCPCS) Codes for
Ambulances (all 0's are Zeros):
- A0425
- Ground Transport Mileage Fee (per loaded mile)
- Same code and fee for all types of ground or
water transport
- Only include miles that the patient is
transported, not distance to pick-up, etc.
- A0426
- ALS Level 1:Non-Emergent Ground Transport
- Response to 911 call or equivalent
- ALS equipped and staffed vehicle
- ALS assessment or at least (1) ALS intervention
- A0427
- ALS Level 1:Emergent Ground Transport
- ALS equipped and staffed vehicle
- ALS assessment or at least (1) ALS intervention
- A0428
- BLS Non-Emergent Ground Transport
- A0429
- BLS Emergency Ground Transport
- Response to 911 call (or equivalent)
- A0430
- A0431
- Rotary-Wing (Helicopter) Air Ambulance
- A0432
- Paramedic Intercept
- Paramedic(s) are provided by an entity other
than the transporting service
- A0433
- ALS Level-2
- ALS equipped and staffed vehicle
- ALS assessment and at least:
- Infusion of at least three intravenous
medications, or
- Performance of at least one of the
following:
- Defibrillation (manual, not AED)
- Cardioversion
- Endotracheal Intubation
- Central venous line
- Cardiac pacing
- Chest decompression
- Surgical airway
- Intraosseous infusion
- A0434
- ALS Specialty Care Transport (SCT)
- Inter-facility transport of critically ill
patient that required medical care or equipment that
exceeds the traditional paramedic level
- Can be staffed by a nurse, physician, special
technician, or paramedic with advanced training
- A0435
- Fixed-Wing Air Transport Mileage (per loaded mile)
- A0436
- Rotary-Wing (Helicopter) Air Transport Mileage (per
loaded mile)
|