Medical Transportation Code Conversion: Policy Overview
The following article initially published in the March 2016 Medi-Cal Update. This update includes policy clarification for the medical transportation code conversion along with corresponding provider manual sections.
Effective for dates of service on or after July 1, 2016, HCPCS Level III local medical transportation codes and HCPCS Level III local modifier Z1 will no longer be reimbursable.
The medical transportation code conversion, announced in the March 2015 Medi-Cal Update, had an initial effective date of April 1, 2015; however, a transition period was established to allow providers time to begin billing with the HCPCS Level II national HIPAA compliant codes. This transition period expired on June 30, 2016.
For dates of service on or after July 1, 2016, medical transportation policy updates include the following:
- HCPCS Level III local medical transportation codes will be discontinued.
- HCPCS Level III local modifier Z1 will be discontinued.
- Medical transportation service claims will no longer allow modifier 99 to indicate multiple modifiers. Claims billed with the 99 modifier will be denied.
- Dry run transport codes and mileage codes will no longer be reimbursable for the same day, same recipient and same provider, unless documentation states that billed mileage was for an actual medical transport at a different time on the same date of service.
- To bill for a dry run transport from an acute care hospital to a Nursing Facility (NF) Level A or B, providers must use A0130, A0426, A0428 or T2005 with modifier HN followed by modifier QN. No other modifiers or service lines may be billed on the claim. This service does not require a Treatment Authorization Request (TAR).
- Previously-approved TARs and Service Authorization Requests (SARs) with medical transportation services that have dates of service beyond June 30, 2016, will no longer be valid. Providers should review their inventory for previously-approved TARs and SARs with medical transportation services that have dates of service beyond June 30, 2016. For those TARs or SARs, providers must submit a new TAR, electronic TAR (eTAR) or SAR with the appropriate HCPCS code to cover any remaining service period after June 30, 2016.
- Modifiers DS or HN must be billed before modifier QN.
- HCPCS code A0380 (BLS mileage, [per mile] [use for wheelchair and litter van transports only]) will be used only for ground mileage (per statute mile) for litter-van and wheelchair transportation for non-emergency services.
- HCPCS code A0390 (ALS mileage [per mile]) will no longer be reimbursable.
- HCPCS code A0424 (extra ambulance attendant, ground [ALS or BLS] or air [fixed or rotary winged], [per hour]) may claim up to a maximum of ten hours per day. A0424 may be used to bill for either emergency or non-emergency services.
- HCPCS code A0425 (ground mileage, per statute mile [use for ambulance transports only]) will be used for ambulance transportation mileage for both emergency and non-emergency services.
- HCPCS code A0433 (advanced life support, level 2 [ALS2]) will become a Medi-Cal benefit.
- HCPCS code A0434 (specialty care transport [SCT]) will become a Medi-Cal benefit.
Note: The code description for A0424 may be condensed in the provider manual to reflect only the relative ground or air component.