Ground Ambulance Transport Services (Emergency and Nonemergency) for Medicare Advantage Members

    Policy Impacted

    MA12.002b: Ground Ambulance Transport Services (Emergency and Nonemergency)


    The purpose of this News Article is to provide advance notice regarding the temporary expansion of the list of allowable destinations for ground ambulance transports in response to the Public Health Emergency (PHE) for the COVID-19 pandemic.

    This News Article addressing Ground Ambulance Transport Services is effective from March 6, 2020 through July 31, 2020 and is subject to re-evaluation for the duration of the public health emergency.


    There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has now been detected internationally. The virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (COVID-19). The SARS-CoV-2 virus has demonstrated the capability to rapidly spread, leading to significant impacts on healthcare systems and causing societal disruption. The potential public health threat posed by COVID-19 is high globally. To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.



    Coverage Statement

    In accordance with the Centers for Medicare & Medicaid Services (CMS), the list of covered destinations for medically necessary ground ambulance transportation (emergency and nonemergency) from any point of origin will be expanded to include, but not limited to, any of the following:
    • any location that is an alternative site determined to be part of a hospital, critical access hospital (CAH), or skilled nursing facility (SNF)
    • community mental health centers
    • federally qualified health centers (FQHCs)
    • rural health clinics (RHCs)
    • physician offices
    • urgent care facilities
    • ambulatory surgical centers (ASCs)
    • any location furnishing dialysis services outside of an end stage renal disease (ESRD) facility when an ESRD facility is not available
    • an individual's home

    Ambulance Services are addressed in policy bulletin MA12.002b Ground Ambulance Transport Services (Emergency and Nonemergency)

    Dosing and Administration


    Black Box Warnings and/or Contraindications



    HCPCS Codes for Ambulance Services:

    A0140 Nonemergency transportation and air travel (private or commercial), intra- or interstate

    A0225 Ambulance service, neonatal transport, base rate, emergency transport, one way

    A0426 Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)

    A0427 Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 - emergency)

    A0428 Ambulance service, basic life support, nonemergency transport (BLS)

    A0429 Ambulance service, basic life support, emergency transport (BLS, emergency)

    A0433 Advanced life support, level 2 (ALS 2)

    A0434 Specialty care transport (SCT)

    Revenue codes for Ambulance Services:

    0540 Ambulance-General Classification

    0542 Ambulance-Medical Transport

    0543 Ambulance-Heart Mobile

    0546 Ambulance-Neonatal Ambulance Services

    0549 Ambulance-Other Ambulance

    Origin and Destination modifiers:

    D Diagnostic or therapeutic site other than P or H when these are used as origin codes; community mental health center, FQHC, RHC, urgent care facility, non-provider-based ASC or freestanding emergency center, location furnishing dialysis services and not affiliated with ESRD facility

    E Residential, domiciliary, custodial facility (other than 1819 facility); residential, domiciliary, custodial facility (other than 1819 facility) if the facility is the beneficiary’s home

    G Hospital based ESRD facility

    H Hospital; alternative care site for hospital, including CAH, provider-based ASC, or freestanding emergency center

    I Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport

    J Freestanding ESRD facility

    N Skilled nursing facility; alternative care site for SNF

    P Physician’s office

    R Residence; beneficiary’s home

    S Scene of accident or acute event

    X Intermediate stop at physician’s office on way to hospital (This is a destination code only)

    Issued on - 04/14/2020

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