Contractors to Process Noncovered Ambulance Services for COB

The Centers for Medicare & Medicaid Services (CMS) has instructed contractors to revise their claims processing systems to allow HCPCS Level II codes identifying noncovered ambulance transportation and transportation-related services into their systems for adjudication. Although these codes (A0021-A0424 and A0998) remain noncovered, accepting these claims will allow providers and suppliers to obtain a Medicare denial so that they may then submit a claim for a patient with Medicare to his or her secondary insurance for coordination of benefits (COB) purposes.

Providers and suppliers should begin submitting ambulance transportation and transportation-related service claims beginning Jan. 1, 2012. Providers and suppliers billing for noncovered ambulance services for the purpose of a Medicare denial should append modifier GY to the appropriate HCPCS Level II code for the service.

Ambulatory Surgical Center CASCC

Source: CMS Transmittal 942, Change Request (CR) 7489, issued Aug. 5, 2011

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