HCPCS Modifier GM

Description
Multiple patients on one ambulance trip.

Guidelines/Instructions
  • This modifier may be submitted only with claims for ambulance transport
  • Submit this modifier second, and the origin/destination modifier first
  • Submit this modifier even if only one of the patients involved in the single trip was a Medicare patient
Documentation Required with the Claim
  • Number of patients transported (including Medicare and non-Medicare patients)
  • Medicare number of each Medicare patient being transported
  • Number of miles traveled for each Medicare beneficiary
  • For electronic claims, submit this documentation in the electronic documentation field
  • For paper claims, submit this documentation as an attachment
References

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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