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Ambulance Coverage Policy

Many Blue Cross and Blue Shield of Alabama contracts include benefits for medically necessary ambulance transportation to the nearest facility able to treat the patient’s condition. Ambulance services are usually covered under the Major Medical portion of the contract, with applicable coinsurance and deductibles.

Hospital-Based Ambulances
Listed below are claims filing instructions for hospital-based ambulances:

1. When a hospital-based ambulance picks up a patient at the site of an emergency and takes the patient to the owner hospital where the patient is admitted, the ambulance service should be included on the inpatient hospital bill and reimbursed as part of the hospital's per diem. No separate payment can be made for the ambulance.

2. When a hospital-based ambulance takes a patient to a non-owner hospital, the ambulance provider should bill services on a separate claim form. These services are not included on the inpatient bill.

3. When a hospital-based ambulance takes an inpatient from one hospital to another hospital for a service that cannot be rendered at that hospital and returns the patient to the original hospital, there is no separate reimbursement for the ambulance. This ambulance service should be included on the hospital claim where the patient is classified as an inpatient.

4. When a hospital-based ambulance picks up a patient from a hospital for the purpose of transferring the patient to another hospital where he is admitted to a non-owner hospital (because the originating hospital cannot provide the necessary care), a separate ambulance claim is submitted. These services are not included on the inpatient bill.

5. When a hospital-based ambulance picks up a patient from a hospital for the purpose of transferring the patient to another hospital where he is admitted to the owner hospital (because the originating hospital cannot provide the necessary care), the ambulance service should be included on the admitting hospital’s bill.

Air Medical Services
In addition to ground ambulance transportation services, many Blue Cross and Blue Shield
of Alabama contracts include benefits for air medical services. These services are provided through AirMed International, LLC. Aircraft used are medically equipped aircraft with specially trained medical teams. AirMed provides fixed wing air ambulance service, not helicopter evacuation. Prior to providing services, AirMed will verify eligibility for transport services based on eligibility under the patient’s Blue Cross and Blue Shield of Alabama group health plan.

Air medical services include:

AirMed International can be contacted 24 hours a day, seven days a week at 1 877 872-8624 toll-free or 205 443-4885 regarding any questions about air transportation.

For All Ambulance Services (Hospital-Based or Independent)
Ambulance origin/destination modifiers are required when filing claims to Blue Cross and Blue Shield of Alabama. These modifiers should be placed to the right of the ambulance Healthcare Common Procedure Coding System (HCPCS) code, with the origin modifier listed first, and the destination modifier listed second. Following is a list of ambulance origin/destination modifiers:

Code Description
D Diagnostic or Therapeutic Site 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 Non-Hospital Based Dialysis Facility
N Skilled Nursing Facility (SNF) (1819 Facility)
P Physician's Office (includes HMO non-hospital 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.)