MLN Matters® Number: MM6621
Related Change Request (CR) #: 6621
Related CR Release Date: September 25, 2009
Effective Date: October 26, 2009
Related CR Transmittal #: R1821CP
Implementation Date: October 26, 2009
Provider Types Affected
Providers and suppliers, submitting claims to Medicare contractors (carriers, Fiscal Intermediaries (FI), and A/B Medicare Administrative Contractors (A/B MAC)) for ambulance services provided to Medicare beneficiaries, are affected.
Provider Action Needed
This article advises ambulance suppliers that CR 6621 communicates claims processing instructions for ambulance service claims submitted for trips with more than one patient onboard. These changes are to be added to the Ambulance chapter of the Medicare Claims Processing Manual (Chapter 15). Please inform your billing staffs of these changes.
Background
This article alerts providers that the Centers for Medicare & Medicaid Services (CMS) is issuing CR 6621 to highlight changes that are to be made to the Medicare Claims Processing Manual, Chapter 15 - Ambulance Services. This article is informational in nature, since CR 6621 revises that manual to incorporate information previously released via transmittal B-02-060, CR 1945, “Payment Policy When More Than One Patient is Onboard an Ambulance” on September 27, 2002, and Transmittal A-02-108, CR 2186, “Multiple Patient Ambulance Transport” on October 25, 2002.
These changes to the Medicare Claims Processing Manual are:
- Ambulance suppliers submitting a claim using the CMS-1500 Form, or the electronic equivalent ANSI X12N 837, for an ambulance transport with more than one Medicare beneficiary onboard must use the HCPCS modifier GM(“Multiple Patient on One Ambulance Trip”) for each service line item. In addition, suppliers are required to submit to B/MACs / Carriers documentation to specify the particulars of a multiple patient transport. The documentation must include the total number of patients transported in the vehicle at the same time and the health insurance claim (HIC) numbers for each Medicare beneficiary. B/MACs / Carriers shall calculate payment amounts based on policy instructions found in the Medicare Benefit Policy Manual, Chapter 10 – Ambulance Services, Section 10.3.10 – Multiple Patient Ambulance Transport.
- For claims with dates of service on or after April 1, 2002, providers must report value code 32 (multiple patient ambulance transport) when an ambulance transports more than one patient at a time to the same destination. Providers must report value code 32 and the number of patients transported in the amount field as a whole number to the left of the delimiter.
Additional Information
The official instruction, CR 6621, issued to your Medicare contractor regarding this change may be viewed at www.cms.hhs.gov/Transmittals/downloads/R1821CP.pdf (PDF, 228 KB) on the CMS Web site.
If you have questions, please contact the Palmetto GBA Provider Contact Center at our toll-free number, (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.