Description
Federally Qualified Health Center.

Guidelines/Instructions

  • Submit this modifier to indicate the destination of an ambulance transport for an ET3 model ambulance claim when the location is a Federally Qualified Health Center
  • Additional documentation may be required to support the need for this ambulance trip 

References

  • CMS Emergency Triage, Treat, and Transport (ET3) Model web page
  • CMS Ambulance website

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


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