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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:
  • 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
      • Fixed-Wing Air Ambulance
    • 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)