The Ambulance Fee Schedule a national fee schedule for ambulance services furnished as a benefit under Medicare Part B. The fee schedule applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers, hospitals, critical access hospitals (except when it is the only ambulance service within 35 miles), and skilled nursing facilities.
Each year, an update is applied to the payment limits for ambulance transports that is equal to the percentage increase in the Consumer Price Index for All Urban Consumers (CPI-U) for the 12-month period ending with June of the previous year.
See also DME Fee Schedule · Carrier Locality Codes
| Carrier | Locality | RVU | GPCI | Base Rate | Urban Base Rate Urban Mileage |
Rural Base Rate Rural Mileage |
Rural Base Rate Lowest Quartile |
Rural Ground Miles (1-7) |
|---|
The fee schedule on this page is for informational purposes only. All official fee schedule files that are used to process Medicare claims are maintained by Medicare Administrative Contractors (MACs) and could vary slightly from the amounts referenced here. Contact your local MAC for official pricing information.
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.
| Service Level | RVU |
|---|---|
A0428 BLS | 1.00 |
A0429 BLS - Emergency | 1.60 |
A0426 ALS1 | 1.20 |
A0427 ALS1 - Emergency | 1.90 |
A0433 ALS2 | 2.75 |
A0434 SCT | 3.25 |
A0432 PI | 1.75 |
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*:
This field displays one of four rates calculated as such*:
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.