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| 2006 Ambulance Fee Schedule |
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Section 1834(1)(3)(B) of the Social Security Act provides the basis for updating payment limits for ambulance services. Specifically, this section provides for an update in payments for 2006 that is equal to the percentage increase in the consumer price index for all urban consumers (CPI-U), for the 12-month period ending with June of the previous year. The resulting percentage is referred to as the Ambulance Inflation Factor (AIF).
The national fee schedule for ambulance services has been phased in over a five-year transition period beginning
April 1, 2002. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) also established that for
ambulance services furnished during the priod July 1, 2004, through December 31, 2009, the ground ambulance base rate is
subject to a floor amount, which is determined by establishing nine fee schedules based on each of the nine census
divisions, and using the same methodology as was used to establish the national fee schedule. If the regional fee
schedule methodology for a given census division results in an amount applies for all providers and suppliers in the
census division. If the regional fee schedule methodology for a given census division results in an amount that is
greater than the national ground base rate, then the fee schedule portion of the base rate for that census division is
equal to a blend of the national rate and the regional rate.
Prior to January 1, 2006, during the transition period, the AIF was applied to both the fee schedule portion of the
blended payment amount (both national and regional (if it applied)) and to the reasonable cost or charge portion of the
blended payment amount separately, respectively, for each ambulance provider or supplier. Then, these two amounts were
added together to determine the total payment amount for each provider or supplier.
As of January 1, 2006, the total payment amount for air ambulance providers and suppliers will be based on
100 percent of the national ambulance fee schedule, while the total payment amount for ground providers and suppliers will
be based on either 100 percent of the national ambulance fee schedule or 60 percent of the national ambulance fee schedule
and 40 percent of the regional ambulance fee schedule.
The AIF for calendar year 2006 is 2.5 percent. Part B coinsurance and deductible requirements apply.
| A0425 |
99 |
1.00 |
0.917 |
1.00 |
6.05 |
6.11 |
| A0426 |
99 |
1.20 |
0.917 |
190.82 |
217.84 |
219.99 |
| A0427 |
99 |
1.90 |
0.917 |
190.82 |
344.91 |
348.32 |
| A0428 |
99 |
1.00 |
0.917 |
190.82 |
181.53 |
183.33 |
| A0429 |
99 |
1.60 |
0.917 |
190.82 |
290.45 |
293.32 |
| A0430 |
99 |
2529.65 |
0.917 |
1.00 |
2424.67 |
3637.00 |
| A0431 |
99 |
2941.08 |
0.917 |
1.00 |
2819.03 |
4228.54 |
| A0432 |
99 |
1.75 |
0.917 |
190.82 |
317.68 |
320.82 |
| A0433 |
99 |
2.75 |
0.917 |
190.82 |
499.21 |
504.15 |
| A0434 |
99 |
3.25 |
0.917 |
190.82 |
589.97 |
595.82 |
| A0435 |
99 |
1.00 |
0.917 |
1.00 |
7.18 |
10.77 |
| A0436 |
99 |
1.00 |
0.917 |
1.00 |
19.14 |
28.17 |
Revised 2/9/06
Note: Q3019 and Q3020 are end dated December 31, 2005, and may no longer be used with dates of service on or after January 1, 2006.
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