A0999, Unlisted ambulance service
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Review the member's benefit plan, summary plan description, or contract to determine coverage, exclusions, and limitations.
- Check applicable state regulations for restrictions or additional requirements.
- Documentation that Emergency Ground Ambulance Transport criteria in Section I are met.
- Clinical documentation of critical condition and/or unstable vital signs, respiratory status, or cardiac status and documentation supporting one of the listed emergent conditions.
Key Coverage Criteria
- The individualâs condition must be such that any form of transportation other than by ambulance would be medically contraindicated;and
- The ambulance must have the necessary equipment and supplies to address the needs of the individual;and
- The use of air and water ambulance services is consideredmedically necessarywhenallthe following criteria are met:
- Transportation to thenearest* appropriate facility for treatment of an individualâs illness or injury when either of the following circumstances exists:Scene of an accident or emergency when there is a medical condition that is life-threatening or first responders (for example, law enforcement officers, emergency medical services members, or fire services members) deem to be life-threatening;orFrom one facility to another when the first facility does not have the required services to treat the [...]
- Scene of an accident or emergency when there is a medical condition that is life-threatening or first responders (for example, law enforcement officers, emergency medical services members, or fire services members) deem to be life-threatening;or
- From one facility to another when the first facility does not have the required services to treat the individual;and
6 Active Policies
ANTHEM-CG-ANC-04, CG-ANC-04 Ambulance Services: Air and Water
ADM1001.005, Ambulance and Transport Services
BCBSIL-MED201.058, Ambulance and Transport Services
BCBSMT-MED201.058, Ambulance and Transport Services
BCBSNM-MED201.058, Ambulance and Transport Services
Related Codes
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