Multiple patients on one ambulance trip.

  • 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

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

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