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HIPAA: Medical Transportation Code Conversion

HIPAA-mandated changes to the billing requirements for the medical transportation code conversion are effective for dates of service on or after July 1, 2016. These changes include the use of the HCPCS Level II national codes. The following FAQs provide an overview of the conversion to HCPCS Level II codes and point to resources for additional information.

  1. What does the conversion from HCPCS Level III codes to HCPCS Level II codes mean?

    The conversion means that any provider submitting HCPCS Level III codes for medical transportation services will be required to submit claims using the specified HCPCS Level II codes for dates of service on or after July 1, 2016.

  2. What is HIPAA and how does it relate to HCPCS Level II codes?

    HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. HIPAA does the following:

    • Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs;
    • Reduces health care fraud and abuse;
    • Mandates industry-wide standards for health care information on electronic billing and other processes; and
    • Requires the protection and confidential handling of protected health information.
  3. Why is the conversion happening?

    California has historically used thousands of HCPCS Level III or local (also known as interim) codes for billing and reimbursement of services and supplies. National codes, such as Current Procedural Terminology (CPT) codes and Healthcare Common Procedural Coding System (HCPCS) codes, are typically more general in nature compared to local codes. Using CPT and HCPCS Level II codes will:

    • Simplify processes and decrease the costs associated with payment for health care services;
    • Improve the efficiency and effectiveness of the health care system and decrease administrative burdens on providers (i.e., medical practices, hospitals and health care plans);
    • Provide standardization and consistency in medical service coding; and
    • Characterize a general administrative situation, rather than a medical condition or service, by using non-clinical or non-medical code sets.
  4. When will this conversion take place?

    The effective date of service for this conversion from HCPCS Level III codes to HCPCS Level II codes is July 1, 2016.

  5. Who is affected by the conversion?

    Any provider submitting medical transportation claims for emergency or non-emergency services with dates of service on or after July 1, 2016, or Treatment Authorization Requests (TARs) or Service Authorization Requests (SARs) with requested dates of service on or after July, 1, 2016, will be required to use HCPCS Level II codes identified in the Medical Transportation Code Conversion Table.

  6. How will the conversion impact my TARs on or after the effective date?

    Effective for dates of service on or after July 1, 2016, TARs and SARs using HCPCS Level III local medical transportation codes and HCPCS Level III local modifier Z1 will no longer be permitted. All TARs and SARs submitted with dates of service on or after July 1, 2016, will require the HCPCS Level II national medical transportation service codes.

  7. How will the conversion impact claims billed with dates of service on or after the effective date?

    Effective for dates of service on or after July 1, 2016, all claims billed with HCPCS Level III local medical transportation codes and HCPCS Level III local modifier Z1 are no longer eligible for reimbursement.

    All TARs with local codes and/or a combination of HCPCS Level III and HCPCS Level II procedure codes, regardless of status (approved, retroactive or deferred), will be end-dated for dates of service on or after July 1, 2016. Providers are encouraged to submit new TARs or electronic TARs (eTARs) with the appropriate HCPCS Level II national code(s) prior to July 1, 2016.

    Providers should refer to the Medical Transportation Code Conversion: Policy Overview article for additional information.

  8. What do I do if my end-dated TAR had a medical authorization assigned to it?

    When replacing end-dated TARs or eTARs that include a medical authorization prior to July 1, 2016, bypass the medical authorization process by including the previously approved TAR number in the Medical Justification field (Box 8C) of the TAR or the Enter Miscellaneous TAR information field (Box 8C) of the eTAR.

  9. If I submit a new TAR/SAR on or after July 1, 2016, which HCPCS Level codes do I use - Level II or Level III?

    Providers submitting new TARs and/or new SARs for service periods on or after July 1, 2016, should no longer use the discontinued HCPCS Level III codes for medical transportation services. New TARs and SARs must use the HCPCS Level II national codes for service periods on or after July, 1, 2016.

  10. How do I use combination modifier codes?

    Modifier HN, which is the combination of ambulance service origin code H (hospital) and ambulance service destination code N (skilled nursing facility), must be used in conjunction with modifier QN (ambulance service furnished directly by a provider of services) for medical transportation for a non-emergency transfer from an acute care facility to Nursing Facility Levels A/B.

    Modifier DS, which is a combination of ambulance service origin code D (diagnostic or therapeutic site other than P or H) and ambulance service destination code S (scene of accident or acute event), must be billed in conjunction with modifier QN (ambulance service furnished directly by a provider of services) for medical transportation for dry run services.

    Modifiers HN and DS must be billed before modifier QN on or after July 1, 2016. Modifiers HN or DS must be placed in the first modifier position on the claim form to ensure reimbursement.

    (Example: A0426 HN + QN OR A0426 + DS + QN)

    Note: A TAR is not required for non-emergency transportation when the transportation is from an acute care hospital to a skilled nursing facility and is indicated by the use of the HN + QN modifier.

  11. Where do I put the modifier on the TAR?

    Applicable modifiers are to be entered in the Medical Justification field (Box 8C) on the TAR or the Enter Miscellaneous TAR Information field (Box 8C) on the eTAR.

    Note: Box 8C on the TAR must include not only the modifier used, but also the description of service provided. (Example: A0130 + UJ, wheelchair service, night transport service)

    Providers are not always required to add modifiers to TARs. However, providers must enter details related to the services requested in the Enter Miscellaneous TAR Information field (Box 8C) of the eTAR and in the Medical Justification field (Box 8C) of the TAR.

    For additional information, providers may view eTAR tutorials, which are accessible on the Provider Training page of the Medi-Cal Learning Portal.

  12. Do I need to use the 99 modifier to indicate multiple modifiers?

    No, it is not necessary to use the 99 modifier to indicate multiple modifiers. Claims using the 99 modifier will be denied.

  13. Should I submit location and destination modifiers on the claim?

    Unless indicated in the Medical Transportation Code Conversion Table, location and destination modifiers should not be included on the claim. Claims submitted with location and destination modifiers, other than those indicated in the crosswalk table, will be denied.

  14. What billing policy changes should I expect to see with HCPCS Level II codes on or after July 1, 2016?

    For dates of service on or after July 1, 2016, medical transportation billing policy will be updated to accommodate the following HCPCS Level II codes:

    HCPCS Level II Codes HCPCS Level II Code Descriptions Modifiers, Instructions and Clarification
    A0380 BLS mileage (per mile) (use for wheelchair and litter van transports only) Modifier HN + QN is to be used for non-emergency wheelchair or litter-van transportation from an acute care hospital to a skilled nursing facility.

    A TAR is not required for non-emergency wheelchair or litter-van transportation from an acute care hospital to a skilled nursing facility.

    Example:
    A0380 + HN + QN (mileage from an acute care hospital to a skilled nursing facility).

    Note: used to bill for non-emergency medical transportation mileage only.
    A0390 ALS mileage (per mile) Discontinued for dates of services on or after July 1, 2016.
    A0425 Ground mileage, per statute mile (use for ambulance transports only) Modifier HN + QN is to be used for non-emergency ambulance transportation from an acute care hospital to a skilled nursing facility.

    A TAR is not required for non-emergency ambulance transportation from an acute care hospital to a skilled nursing facility.

    Example:
    A0425 + HN + QN (mileage from an acute care hospital to a skilled nursing facility)

    Note: can be used to bill for emergency or non-emergency ambulance mileage only.
    A0433 Advanced life support, level 2 (ALS2) Modifier UN is to be used for two patients served.

    Modifier UJ is to be used for night calls, 7 p.m. to 7 a.m.

    Modifier DS + QN is to be used for no transport (dry run).

    Examples:
    A0433 + UN (two patients served)

    A0433 + UJ (services provided at night)

    A0433 + UN (two patients served) +UJ (services provided at night)

    A0433 + DS + QN (ambulance response, no transport)

    Note: should be used to bill for emergency ambulance transportation only.
    A0434 Specialty care transport (SCT) Modifier UN is to be used for two patients served.

    Modifier UJ is to be used for night calls, 7 p.m. to 7 a.m.

    Modifier DS + QN is to be used for no transport (dry run).

    Examples:
    A0434 + UN (two patients served)

    A0434 + UJ (services provided at night)

    A0434 + UN (two patients served) + UJ (services provided at night)

    A0434 + DS + QN (ambulance response, no transport)

    Note: should be used to bill for emergency ambulance transportation only.
  15. How do I indicate emergency or non-emergency when using the same procedure code?

    Providers must indicate if emergency services are provided by using the appropriate HCPCS Level II code(s) and marking the EMG field (Box 24C) on the CMS-1500 claim form or by including condition code 81 (emergency indicator) on the UB-04 claim form. Providers may refer to the Medical Transportation – Ground and Medical Transportation – Air sections of the Part 2 manual for further instruction.

    Providers must indicate if non-emergency services are provided by using the appropriate HCPCS Level II code(s) with an associated TAR (e.g. A0420 or A0425). One exception applies when the transportation is from an acute care hospital to a skilled nursing facility; in this scenario, use modifiers HN + QN.

  16. How do I indicate number of patients transported?

    To indicate the number of patients receiving non-emergency services, use the appropriate modifier in the Medical Justification field (Box 8C) on the TAR.

    To indicate the number of patients receiving emergency services, use the appropriate modifiers.

  17. Where do I find more information related to the medical transportation conversion from Level III HCPCS codes to Level II HCPCS codes?

    Providers may request additional onsite or telephone support via the Telephone Services Center (TSC) at 1-800-541-5555, available 8 a.m. to 5 p.m., Monday through Friday.

    For additional information, providers may:

    Providers who would like to receive monthly email notification for newly published Medi-Cal Update bulletins should complete the MCSS Subscriber Form.