Subscribe to eNews Contact us

Ambulance transport - multiple patients

When an ambulance transport has included multiple patients, Medicare has billing and payment guidelines based on the scenario. The most common occurrence of this is at the scene of an accident. It doesn't matter whether all injured parties transported are Medicare patients or not. 

Two patients

  • Transported simultaneously to the same destination.
  • Medicare allows 75% of the payment allowance for the base rate applicable to the level of care provided (for each Medicare beneficiary).
  • For payment, Medicare allows 50% of the total mileage payment allowance for the entire trip.

Three or more patients

  • Transported simultaneously to the same destination.
  • Medicare allows 60% of the base rate applicable to the level of care provided (for each Medicare beneficiary).
  • Single payment allowance for mileage, prorated by the number of patients onboard. 

Billing instructions

Part A institutional ambulance provider 

  • Report value code 32 to indicate multiple patients in ambulance along with the number of patients transported. 
  • Append the origin/destination modifiers on each line of service. 

Part B ambulance supplier

Bill full trip charge amount and First Coast will calculate the payment as stated above. 

Report the value code 32 or the GM modifier even if only one of the patients involved in the single trip was a Medicare patient.

This policy applies to both ground and air transports.

Documentation required with the claim

  • Number of patients transported (including Medicare and non-Medicare patients).
  • Medicare beneficiary identifier (MBI) of each Medicare patient being transported.
  • Number of miles traveled for each Medicare beneficiary.

For electronic claims, submit this documentation in the electronic documentation field.

For paper claims, submit this documentation as an attachment.

NOTE: If this required information is not provided, the claim will be denied.

 

References