HCPCS A0998: Ambulance Response and Treatment, No Transport

Learn more about the HCPCS code A0998, its documentation and billing requirements, and how to properly use and code it from our short guide.

Use Code

## **What is HCPCS code A0998?** HCPCS code A0998, which falls under the category "Ambulance and Other Transport Services and Supplies", has a description of "Ambulance response and treatment, no transport". This code is used when emergency medical services (EMS) providers arrive at the scene, assess the patient, and render treatment according to approved medical protocols, but the patient is stable and either refuses transport or is not deemed to require hospital transport. Coverage is variable and often depends on the specific commercial payer, state Medicaid rules, or Medicare Advantage plan. Many major commercial insurers (like Anthem) do cover it when medical necessity and treatment criteria are met. Do note that it is not covered by Original Medicare (typically status indicator 'I'), meaning it is not valid for Medicare reimbursement. However, some Medicare Advantage Plans or state Medicaid programs may cover it.

## **HCPCS code A0998 documentation requirements** Accurate documentation is critical for billing A0998, as it must support the medical necessity of the services rendered. - **Treatment must be rendered**: The most important requirement is that the EMS provider must render treatment to the patient. Billing A0998 when treatment is not rendered is considered inappropriate. - **Adherence to protocols**: The treatment rendered must be in accordance with EMS protocols approved by the medical director at the local or state level. - **Medical necessity**: Documentation must demonstrate the encounter meets the payer's criteria for medical necessity, which often involves a review against a specific coverage guideline. - **Detailed records**: The documentation should reflect the moderate-level medical decision-making, which may include multiple diagnoses, medication management, or test interpretation, consistent with a moderate-complexity encounter.

## **A0998 billing requirements** Billing practices for A0998 are heavily dependent on the payer (e.g., Medicare, Medicaid, or commercial insurer). ### **General guidelines** - **Medical necessity**: The service must be medically necessary and provided in response to an emergency call. - **Treatment requirement**: Treatment must be rendered according to EMS protocols. - **Place of Service (POS)**: For ambulance services, the appropriate POS codes are typically 41 (Ambulance – Land) or 42 (Ambulance – Air or Water), though specific payer rules may vary for non-transport claims. - **Modifiers**: For most transport codes, origin and destination modifiers (e.g., R/S, H/H) are required. However, for A0998, some payers indicate that origin and destination modifiers are not required or may specify a single acceptable modifier (e.g., 'SS' for some Medicaid plans). Always consult the specific payer's policy. ### **Payer-specific notes** - **Original Medicare**: A0998 is not payable by Original Medicare. To receive a proper denial for non-covered services (to then bill the patient or secondary insurance), providers may be instructed by Medicare Administrative Contractors (MACs) to submit the claim with the unlisted ambulance service code A0999 and append the GY modifier (indicating a statutorily excluded service), along with a comment like "Patient refused transport" in Item 19 of the CMS-1500 form. - **Commercial payers/Medicaid**: If a commercial insurer or state Medicaid plan covers A0998, they will generally require it to be billed only when the criteria for treatment at the scene without transport are fully met, often subject to their internal medical necessity reviews.

## **Other relevant codes** - **A0428**: Ambulance service, Basic Life Support (BLS), non-emergency transport. - **A0429**: Ambulance service, Basic Life Support (BLS), emergency transport. - **A0426**: Ambulance service, Advanced Life Support, non-emergency transport, Level 1 (ALS1). - **A0427**: Ambulance service, Advanced Life Support, emergency transport, Level 1 (ALS1-Emergency). - **A0433**: Ambulance service, Advanced Life Support, Level 2 (ALS2). - **A0999**: Unlisted ambulance service. Used by Medicare for non-covered non-transport services to obtain a denial. - **A0888**: Noncovered ambulance mileage, per mile.

Frequently asked questions

No. Medicare generally considers this code invalid for reimbursement. For claims where treatment but no transport was provided, providers often bill the unlisted code A0999 with modifier GY to get a denial, which may then allow them to bill the patient.

It is appropriate to bill A0998 when an EMS crew responds to an emergency, provides appropriate and medically necessary treatment to the patient on-site, and the patient is not transported to the hospital.

No. The EMS provider must render treatment per protocol. Billing A0998 when treatment is not rendered is not appropriate.