|
| 2008 Ambulance Fee Schedule |
|
< Back to the Ambulance Fee Schedules page
Section 1834(l)(3)(B) of the Social Security Act (the Act) provides the basis for updating payment limits that carriers, fiscal intermediaries (FIs), and Part A/B Medicare Administrative Contractors (A/B MACs) use to determine how much to pay you for the claims that you submit for ambulance services.
Specifically, this section of the Act provides for a 2008 payment update that is equal to the percentage increase in the urban consumer price index (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 AIF for calendar year (CY) 2008 will be 2.7 percent.
The national fee schedule for ambulance services was phased in over a five-year transition period beginning April 1, 2002. Further, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established that the ground ambulance base rate (for services furnished during the period July 1, 2004, through December 31, 2009) is subject to a "floor amount."
Payment will not be less than this "floor," which is determined by establishing nine fee schedules (one for each of the nine census divisions) and then using the same methodology that was used to establish the national fee schedule
Some key issues related to the AIF include:
National or Regional Fee Schedules
Either the national fee schedule or regional fee schedule applies for all providers and suppliers in the census division, depending on the payment amount that the regional methodology yields. The national fee schedule amount applies when the regional fee schedule methodology results in an amount (for a given census division) that is lower than the national ground base rate. Conversely, the regional fee schedule applies when its methodology results in an amount (for the census division) that is greater than the national ground base rate. When the regional fee schedule is used, that census division's fee schedule portion of the base rate is equal to a blend of the national rate and the regional rate.
Payments Based on Blended Methodology
During the five-year transition period, your payments have been based on a blended methodology. For CY 2008, this blend is 20 percent regional ground base rate and 80 percent national ground base rate.
Before January 1, 2006, for each ambulance provider or supplier, 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 amount. Then, these two amounts were added together to determine each provider or supplier's total payment amount. As of January 1, 2006, the total payment amount for air ambulance providers and suppliers is based on 100 percent of the national ambulance fee schedule. As of January 1, 2008, the total payment amount for ground ambulance providers and suppliers is based on either 100 percent of the national ambulance fee schedule or 80 percent of the national ambulance fee schedule and 20 percent of the regional ambulance fee schedule, whichever is greater.
The Ambulance Fee Schedule Fact Sheet, which provides general information about the Ambulance Fee Schedule, is available in downloadable format from the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network at www.cms.hhs.gov/MLNProducts/downloads/AmbulanceFeeSched_508.pdf.
Part B Coinsurance and Deductible Requirements
Part B coinsurance and deductible requirements apply.
| A0425 |
99 |
6.42 - for dates of service 1/1/08 - 6/30/08 |
6.42 - for dates of service 1/1/08 - 6/30/08 |
| 6.55 - for dates of service on or after 7/1/08 |
6.61 - for dates of service on or after 7/1/08 |
| A0426 |
99 |
228.70 - for dates of service 1/1/08 - 6/30/08 |
228.70 - for dates of service 1/1/08 - 6/30/08 |
| 233.28 - for dates of service on or after 7/1/08 |
235.56 - for dates of service on or after 7/1/08 |
| A0427 |
99 |
362.11 - for dates of service 1/1/08 - 6/30/08 |
362.11 - for dates of service 1/1/08 - 6/30/08 |
| 369.35 - for dates of service on or after 7/1/08 |
372.97 - for dates of service on or after 7/1/08 |
| A0428 |
99 |
190.58 - for dates of service 1/1/08 - 6/30/08 |
190.58 - for dates of service 1/1/08 - 6/30/08 |
| 194.40 - for dates of service on or after 7/1/08 |
196.30 - for dates of service on or after 7/1/08 |
| A0429 |
99 |
304.93 - for dates of service 1/1/08 - 6/30/08 |
304.93 - for dates of service 1/1/08 - 6/30/08 |
| 311.03 - for dates of service on or after 7/1/08 |
314.08 - for dates of service on or after 7/1/08 |
| A0430 |
99 |
2599.92 |
3899.88 |
| A0431 |
99 |
3022.78 |
4534.17 |
| A0432 |
99 |
333.52 - for dates of service 1/1/08 - 6/30/08 |
333.52 - for dates of service 1/1/08 - 6/30/08 |
| 340.19 - for dates of service on or after 7/1/08 |
343.53 - for dates of service on or after 7/1/08 |
| A0433 |
99 |
524.11 - for dates of service 1/1/08 - 6/30/08 |
524.11 - for dates of service 1/1/08 - 6/30/08 |
| 534.59 - for dates of service on or after 7/1/08 |
539.83 - for dates of service on or after 7/1/08 |
| A0434 |
99 |
619.40 - for dates of service 1/1/08 - 6/30/08 |
619.40 - for dates of service 1/1/08 - 6/30/08 |
| 631.79 - for dates of service on or after 7/1/08 |
637.98 - for dates of service on or after 7/1/08 |
| A0435 |
99 |
7.69 |
11.54 |
| A0436 |
99 |
20.50 |
30.75 |
Updates to the 2008 Ambulance Fee Schedule
- The rural allowance for code A0435 was changed from $11.53 to $11.54, effective for dates of service on or after January 1, 2008. This fee change was implemented in the Medicare claims processing system on February 26, 2008. This change is reflected in the fee schedule listed above.
- Section 146(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) established new 2008 payment rates for ground ambulance services, effective for dates of service July 1, 2008, through December 31, 2009. This change is reflected in the fee schedule listed above.
|
|
