Origin/Destination Ambulance Modifiers

Ambulance providers are reminded to use the applicable origin and destination modifiers correctly when submitting their claims to Palmetto GBA. These HCPCS modifier descriptions are:

D = Diagnostic or therapeutic site other than P or H when these are used as origin codes
E = Residential, domiciliary, custodial facility (other than 1819 facility)
G = Hospital-based ESRD facility
H = Hospital
I = Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport
J = Freestanding ESRD facility
N = Skilled nursing facility
P = Physician office
R = Residence
S = Scene of accident or acute event
X = Intermediate stop at physician’s office on way to hospital (destination code only)

It has come to Palmetto GBA’s attention that some providers may be using D HCPCS modifier as a destination modifier when the trip has actually been to the physician office. This could be for evaluation, follow-up, dressing changes, etc. HCPCS modifier P must be used when the physician’s office is the destination; do not use D HCPCS modifier for such trips.  

A trip to a physician’s office is not a covered Medicare service unless ambulance transport is en route to a Medicare covered destination and during the transport the ambulance stops at a physician’s office because of the patient’s dire need for professional attention, and immediately thereafter, the ambulance continues to the covered destination.

Note: In such situations, the ambulance provider may only bill for one base rate and may bill for the entire mileage travelled. 

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