HCPCS Code A0426: Ambulance Service, Advanced Life Support, Non-Emergency Transport, Level 1 (ALS 1)

Learn about the HCPCS code A0426 for a non-emergency, level 1 ambulance service transport with advanced life support through this guide.

Use Code

## **What is the HCPCS code A0426 for?** The HCPCS code for A0426 is classified under the HCPCS category Transportation Services Including Ambulance, Medical & Surgical Supplies. This code in particlar is meant to designate a non-emergency ambulance service transport that has level 1 advanced life support. This means this service does not require an immediate response. It's a routine or scheduled transport. This type of ambulance service is often used to transport patients to or from hospitals, skilled nursing facilities, dialysis centers, or other medical appointments. It's also meant for patients who require stretchers and advanced life support, including those who can't be safely transported by car, van, or wheelchair. The staff inside this ambulance are trained to provide life support beyond the basics, in case the patient requires it. Patients with the following indications are usually transported with this kind of ambulance: - If they require medical supervision/regular monitoring during transit - If they require advanced life support during transit - If they require certain medications during transit - If they have mobility issues/severe disabilities If you're wondering what ALS 1 entails, it involves assistance from paramedics who provide interventions such as continuous ECG monitoring, multiple IV infusions, and administration of medications. Although not for emergencies, the required level of care exceeds that of basic life support (BLS).

## **Documentation requirements for A0426** As with any HCPCS code, it's important to have sufficient documentation that meets the correct coding guidelines and requirements, along with related policy articles and local coverage determinations (e.g., Medicare guidelines for Medicare billable services). Here are examples of what you need: - The full name of the patient - Signed and dated Provider Certification Statement (PCS), if applicable, for verifying medical necessity - Trip report/run sheet documenting pick-up and drop-off locations, the patient's condition and need for ambulance transport, paramedic notes, and services provided during transport - Reasons why the patient can't be transported by other means to justify medical necessity - Crew signatures/healthcare provider signatures and their credentials - Patient medical record - Documentation supporting bed confinement - Signature attestation (if applicable) - Beneficiary signature - Signature of accepting facility representative - Abbreviation key (if applicable) - Advance Beneficiary Notice (ABN) (if applicable) We recommend submitting your documentation to Medicare or whichever insurer/payment providers you're tied to for review before services are rendered and before claims are submitted for payment to prevent performing costly services that Medicare or your insurer will not cover, and so you can go about identifying potential billing issues.

## **Billing requirements for A0426** Besides the documentation requirements above, it's important to take note or have the following: - 1 one-way trip = 1 unit of service - Origin and destination modifiers required (e.g., RH = residence to hospital, SN = skilled nursing facility to nursing facility), plus either QM or QN modifier depending on whether it’s arranged by another provider or delivered directly - Medicare and other payers covered only if the medical necessity for ambulance transport is met - Non-emergency transports often require prior authorization - A separate line must bill for mileage using A0425 (ground mileage per statute mile), ensuring it’s filed separately with its own revenue code line - If you're filing a claim through a service that uses electronic comparative billing reports for ambulance transport services, please make sure you know how to fill out such forms; if you need to get in touch with provider contact centers and their customer service representatives, please do so to make sure everything you're doing is correct, or if you need guidance - If part of repetitive, scheduled non-emergency transports (RSNAT), documentation must be submitted per PA protocols beginning from the fourth service

## **Other similar codes** - **A0429** - Ambulance service, basic life support, emergency transport (bls-emergency) - **A0427** - Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) - **A0422** - Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation - **A0304** - Ambulance service, advanced life support (als), non-emergency transport, no specialized als services - **A0425** - Ground mileage, per statute mile

Frequently asked questions

Mileage is billed separately using A0425 with its own line item; A0426 covers the service only.

Please include both an origin/destination modifier (e.g., "RN") and either QM (under arrangement) or QN (provider-direct). For non-emergency transports, an attending physician's NPI in the claim is required.

For RSNAT services, PA must be obtained before rendering or billing from the fourth transport onward to secure Medicare coverage.