GHP Family ambulance billing guidelines: Combining HCPCS units for same-day trips

Ambulance providers billing GHP Family must follow specific guidelines when submitting claims for multiple trips on the same date of service (DOS). These guidelines ensure accurate reimbursement and compliance with Pennsylvania DHS regulations.

Combining units for same-day trips

When a member receives multiple ambulance transports on the same day, and the same HCPCS code/modifier combination applies to each trip:

• Submit a single claim line for each HCPCS code/modifier combination.
• Combine the units to reflect the total number of episodes in block 24G (Units) of the CMS-1500 claim form.

Example: For two Basic Life Support (BLS) transports and associated mileage:

Documentation requirements

Providers must document in the beneficiary’s file the reason for billing more than one unit of the same HCPCS code/modifier combination. This documentation should include:

• Trip details (e.g., time, origin, destination)
• Medical necessity for each transport
• Supporting documents such as Patient Care Reports (PCRs) or trip tickets
  
  

Mileage billing guidelines

Ground ambulance mileage (A0425)

• Bill loaded miles only (i.e., miles traveled with the patient onboard).
• Enter the total loaded miles in Block 24G.

Air ambulance mileage

• Bill only for loaded miles beyond the first 20 miles.
• Example: For a 100-mile round trip, enter 80 miles in block 24G.
  
  

Modifiers and place of service

• Use appropriate two-character ambulance service modifiers to indicate origin and destination (e.g., SH for Scene to Hospital).
• Include the place of service code:
• 41 for land ambulance
• 42 for air ambulance
  
  

See our GHP Family Provider Manual and our ambulance transport service medical benefit policy (MP017) for more information about ambulance transport for GHP Family members.