by Jared Staheli
June 25th, 2015
Medically necessary ambulances provided by an IHS ambulance supplier are paid based upon Chapter 15 of Pub. 100-04, Medicare Claims Processing Manual. Suppliers must report an origin and destination code for each ambulance service billed.
Modifier Reporting –
Origin and destination modifiers used for ambulance services are created by combining two alpha characters. Each alpha character, with the exception of “x”, represents an origin code or a destination code. The pair of alpha codes creates one modifier. The first position alpha code equals origin; the second position alpha code equals destination. Origin and destination codes are listed below:
D - Diagnostic or Therapeutic Center other than P or H when these are used as origin codes
E - Residential, Domiciliary, Custodial Facility (Other than an 1819 Facility)
G - Hospital based dialysis facility (hospital or hospital related)
H – Hospital
I - Site of Transfer (e.g., airport or helicopter pad) between modes of ambulance transport
J - Nonhospital based dialysis facility
N - SNF (1819 Facility)
P - Physician's Office (Includes health maintenance organization (HMO) nonhospital facility, clinic, etc.)
R – Residence
S - Scene of Accident or Acute Event
X - (Destination code only) intermediate stop at physician's office enroute to the hospital (includes HMO non-hospital facility, clinic, etc.)
All claims processing requirements in Chapter 15 of Pub. 100-04, Medicare Claims Processing Manual, shall apply to ambulance claims submitted by IHS independent ambulance suppliers.
The MSN is suppressed.