We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
Ambulance mileage services under the prior authorization model, HCPCS code A0425, have been originally paid in error because the transport for the same date of service was denied for prior authorization coverage. Providers should refund the payment upon receipt of the overpayment letter that will be sent as mass adjustments are periodically performed.
The criteria for these adjustments are as follows:
Some providers have seen a denied transport when viewing the remittance advice (RA) in eServices but did not see a line item for the mileage even though it was billed on the same claim. The reason the mileage is not seen is that the claim is being split. The denial of the transport due to prior authorization is being split into a separate claim and the RA is being sent out immediately while the mileage claim (since it is being paid) is on a separate claim awaiting the 14 day payment floor. Then the mileage payment is made on a separate RA.
Since the mileage is paying in error due to a system limitation, mass adjustments are made periodically to request that payment back as it is an overpayment. This was previously listed as an issue on the Claims Payment Issues Log (CPIL) and the Prior Authorization webpage. It is resolved as there is a process in place to address any impacted claims.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article try to revise or expand it. In the meantime we recommend you:
Last Updated: 04/18/2017
Applies to: JM Part B, Prior Authorization
Article Topics: Appeals, Redeterminations, and PTANs