2024 Ambulance Fee Schedule for A0433

This is the identifier used by the Centers for Medicare and Medicaid Services to identify the entity which has the responsibility for adjudicating and paying claims within a defined geographical location.

This field represents subsets of locations within a defined jurisdiction with different GPCI's.

RVUs set a numeric value for ambulance services relative to the value of a base level ambulance service. Since there are marked differences in resources necessary to furnish the various levels of ground ambulance services, different levels of payment are appropriate for the various levels of service. The different payment amounts are based on level of service. An RVU expresses the constant multiplier for a particular type of service (including, where appropriate, an emergency response). An RVU of 1.00 is assigned to the Basic Life Support (BLS) level of ground service, i.e., BLS has an RVU of 1; higher RVU values are assigned to the other types of ground ambulance services, which require a higher level of service than BLS.

The GPCI for the practice expense portion of the Medicare physician fee schedule is used to adjust payment to account for regional differences. The geographic areas applicable to the ambulance fee schedule are the same as those used for the physician fee schedule.

The location where the beneficiary was put into the ambulance (“point of pickup”) establishes which GPCI applies. For multiple vehicle transports, i.e., where ground ambulance transports to an air ambulance, each leg of the transport is separately evaluated for the applicable GPCI.

Thus, for the second (or any subsequent) leg of a transport, the point of pickup establishes the applicable GPCI for that portion of the ambulance transport.

The Base Rate is a nationally uniform “base” amount used to calculate each HCPCS payment amount.

This field displays one of four rates calculated as such*:

1. Urban ground base rates –
   (RVU * (.3 + (.7 * GPCI))) * BASE RATE * 1.02
2. Urban air base rates –
   ((BASE RATE * .5) + (BASE RATE * .5 * GPCI)) * RVU
3. Urban ground mileage rates –
   BASE RATE * 1.02
4. Urban air mileage rates –
   BASE RATE * 1.00

This field displays one of four rates calculated as such*:

1. Rural ground adjusted base rates –
   (RVU * (.3 + (.7 * GPCI))) * BASE RATE * 1.03
2. Rural air adjusted base rates –
   ((BASE RATE * .5) + (BASE RATE * .5 * GPCI)) * RVU * 1.5
3. Rural ground mileage rates –
   BASE RATE * 1.03
4. Rural air mileage rates –
   BASE RATE * 1.50

The “super-rural bonus” payment rate applies only to ground ambulance transports originating in a rural area determined by the Secretary to be in the lowest 25th percentile of all rural populations arrayed by population density. Medicare contractors will apply this amount to the base rate when the point of pickup (POP) is in one of a group of designated rural ZIP codes. In order to calculate the “super-rural bonus“ payment rate of 22.6%, multiply any rural ground ambulance transport service payment rate by .226.

For example, for HCPCS A0428 (BLS), for Carrier 01112, Locality 05, use the rural rate of $286.18 and multiply by 0.226 for a bonus payment rate (286.18 * 0.226 = 64.68) and then add that bonus rate to the rural rate (286.18 + 64.68 = 350.86).

This field displays the amounts for rural ground miles 1-17. For ground rural miles 1-17, the mileage rate for ground transports provided in a rural area is 1.5 times the rural mileage rate per mile.
(The urban ground mileage rate applies to all miles of an ambulance transport originating in an urban area.)

This field displays a rural amount for the air base rate and air mileage. The amount payable for the base rate and all air miles for all air transportation originating in a rural area is 1.5 times the urban air base and mileage rates.