Specialty billing
Emergency medicine billing services for EMS and ambulance providers
Emergency medicine billing for EMS and ambulance providers is coding and claiming each transport: the level of care given on the way, the miles the patient was carried, and where they were picked up and taken.
Emergency medicine
One level per transport
- BLSA0429A0428 non-emergency
- ALS level 1A0427A0426 non-emergency
- ALS level 2A0433
- Specialty careA0434
Try it
Build a transport’s claim line
The level of care, where the trip began and ended, and the loaded miles, as the claim carries them.
Build the trip’s claim line
HCPCSThe level is set by the care the patient needed and was given.
From
To
- A0429SH
- A0425× 12.4 mi
SH: the scene of an accident or acute event to a hospital. Only miles with the patient on board count, and Medicare wants them to a tenth of a mile on trips under 100 miles.
Why is EMS billing hard?
The level billed has to match the care
Each transport is billed at one HCPCS level: BLS (A0428, A0429), ALS1 (A0426, A0427), ALS2 (A0433) or specialty care transport (A0434). The level is set by the care the patient needed and was given, not by the vehicle that was sent.
Medical necessity is read from the trip report
Medicare pays for an ambulance only when any other way of travelling would have endangered the patient, and the patient care report’s narrative is what shows it. A thin narrative turns a necessary transport into a denial.
Origin, destination and mileage on every claim
Each claim carries a two-letter modifier for where the trip began and ended (RH: residence to hospital; SH: scene to hospital), the ZIP code of the pickup, and the loaded miles, which Medicare wants to a tenth of a mile on trips under 100 miles.
Non-emergency trips need paperwork first
Many non-emergency transports need a physician certification statement, and Medicare requires prior authorization for repetitive scheduled trips, such as regular trips to dialysis. Without them the trip isn’t paid, however well it was run.
What Beeline handles for EMS and ambulance providers
- Claims submissionTrip sheets reviewed for what a claim needs, such as the pickup ZIP code, signatures and the narrative, before charges are entered and claims are sent.
- Medical codingEach trip coded from the patient care report: the level of service, the mileage, and the origin and destination modifiers.
- Eligibility verificationCoverage found and checked after the call, since a patient’s insurance often isn’t known at pickup.
- Denial managementMedical-necessity and level-of-service denials worked from the narrative, then corrected or appealed with the documents the payer needs.
- Payment postingPayments from Medicare, Medicaid and private payers posted against each trip, with underpayments flagged.
EMS and ambulance billing questions
What is the difference between BLS and ALS ambulance billing?
What are ambulance origin and destination modifiers?
How is ambulance mileage billed?
Find out where your emergency medicine billing stands.
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