HCPCS Code A0428: Ambulance Service, Basic Life Support, Non-Emergency Transport, (BLS)

Learn about the HCPCS code A0428 for "ambulance service, basic life support, non-emergency transport, (BLS)" through this short guide.

Use Code

## **What is the HCPCS code A0428 for?** The HCPCS code A0428 is under the category Transportation Services Including Ambulance, Medical & Surgical Supplies. This code designates a non-emergency ambulance service transport that has basic life support. This means this service does not require an immediate response. It's very likely these are just routine and/or scheduled transports. This type of ambulance service is often used to transport patients to or from hospitals, skilled nursing facilities, dialysis, or other medical appointments. It's also meant for patients who require stretchers and those who cannot be safely transported in a car, van, or wheelchair. It also has equipment for medical monitoring and basic interventions such as oxygen and basic first aid. Patients with the following indications are usually transported with this kind of ambulance: - If they require medical supervision during transit - If they require transport for non-urgent appointments or procedures - If they require specific medical equipment during transport - If they have mobility issues or severe disabilities

## **Documentation requirements for A0428** 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 coverage). Here are examples of what you need: - The full name of the patient - Signed and dated Provider Certification Statement (PCS) if , 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, and services provided during transport - Reasons why the patient can't be transported by other means to justify medical necessity - Crew 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 you're tied to for review before services are rendered and before claims are submitted for payment to prevent performing costly services that Medicare will not cover.

## **Billing requirements for A0428** 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) - Medicare and other payers cover only if medical necessity for ambulance transport is met - Non-emergency transports often require prior authorization - Please note that Medicare's benefit for ambulance services is a “transport” benefit. Without a transport to a Medicare-covered destination, there is no Medicare billable service - 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 - Please note that, if your insurer is Medicare, Medicare regulations require, providers who submit claims for repetitive services will have to submit documentation for every claim from the fourth service forward

## **Other similar codes** - **A0429** - Ambulance service, basic life support, emergency transport (bls-emergency) - **A0426** - Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) - **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

Frequently asked questions

A0428 is for a BLS non-emergency transport. A0429 is for emergencies.

No. Mileage must be billed separately with A0425.

For non-emergency, scheduled repetitive transports (e.g., dialysis), Medicare generally requires a PCS form. For unscheduled non-emergent transports, detailed documentation is still required.