Ambulance billing

January 2023

Developed by the Health Industry Collaboration Effort (HICE) Encounters Standardization Team, this presentation is a training tool to address correct billing processes and educate service providers on proper claims submission for ambulance services. Ambulance billing was identified as a leading cause of duplicate encounter submissions, so these best practices were developed to help organizations reduce the number of duplicates.

Author

Health Industry Collaboration Effort (HICE) Encounters Standardization Team

Why use it

Improper coding, such as any repeat ambulance HCPCS codes billed for the same date of service without the required unique modifier, can trigger a duplicate error in an encounter submission. The Ambulance Billing Best Practice provides clear and consistent guidance for various scenarios that occur with ambulance transportation services. Use this presentation as a quick tool and resource when coding encounters.

Who it’s for

The Ambulance Billing Best Practice is intended for all healthcare organizations, including health plans, provider organizations, and delegates, that work with claims or encounters for ambulance services.

Key take-aways

This presentation provides information and examples for:

  • Submitting multiple trips for ambulance services in the same day / use of modifiers / X12 837 data showing for multiple trips
  • X12 837 mapping requirement on ambulance transport
  • Direct Medi-Cal fee-for-service ambulance claim example
  • Guidance on submitting homeless ambulance transportation services

Have edits or additions for this resource? Please let us know.

IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

Share This