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Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing (AMB)
Effective April 1, 2002, system edits were implemented to identify HCPCS codes for ambulance services that are either subject to or excluded from skilled nursing facility (SNF) consolidated billing. This coding change added system edits to deny payment of some separately billed ambulance services for beneficiaries in a SNF Part A covered stay. Since the implementation of the edits for the separately billed codes, additional HCPCS codes for ambulance and ancillary services have been identified that were inadvertently omitted from this update.
When billing for ambulance transports, suppliers should indicate whether the transport was part of a SNF Part A covered stay, using the appropriate origin/destination modifier (e.g., "NH" for a transport from a SNF to a hospital). Suppliers should bill with an "NN" origin/destination modifier when a SNF to SNF transport occurs. A transport between two SNFs is not separately payable when a beneficiary is in a Part A covered SNF stay, and will result in a denial of a claim for such a transport. An inter-SNF transport of a beneficiary not in a Part A stay is separately payable.
Effective August 22, 2002, HCPCS codes A0999, A0382, A0384, A0392, A0394, A0396, A0398, A0420, A0422, A0424, Q3019, and Q3020 will be added as codes subject to SNF consolidated billing. These codes will be denied for payment when submitted with an "NN" modifier and the beneficiary is in a Part A covered stay.
There is a possibility of incorrect processing of claims submitted with these HCPCS codes (except when billed with the "NN" modifier) for beneficiaries in a Part A covered SNF stay, and for claims submitted with the "NN" modifier when the beneficiary is not in a Part A stay. The claims that may be affected include any submitted with the "A" HCPCS codes listed above with dates of service between April 1, 2001, and August 22, 2002, and claims submitted with HCPCS codes Q3019 or Q3020 with dates of service between April 1, 2002, and August 22, 2002. New claims submitted on or after August 23, 2002, will process correctly. Suppliers should resubmit claims for services processed incorrectly during this time period to their carrier for reprocessing. |
