The policy of paying for ambulance services according to the medically necessary services actually furnished continues to apply under the National Ambulance Fee Schedule (FS), which was implemented April 1, 2002. In other words, payment is based on the level of service provided, not on the vehicle used. Even if a local government requires an advanced life support (ALS) response for all calls, Medicare pays only for the level of service provided, and then only when the service is medically necessary. The use of codes Q3019 and Q3020 described below is effective only during the 5-year transition period.

ALS Vehicle Used, Emergency Transport, No ALS Service Furnished

During the transition period, if an ALS vehicle is used for an emergency transport, but no ALS level service is furnished, the FS portion of the blended payment will be based on the emergency basic life support (BLS) level. The amount on the FS for HCPCS Q3019 is the same fee as BLS-Emergency (BLS-E), FS HCPCS A0429. The reasonable charge portion of the blended payment will be the ALS emergency rate.

Note: Code Q3019 applies only when the ALS crew did not perform an ALS assessment.

ALS Vehicle Used, Non-Emergency Transport, No ALS Service Furnished

During the transition period, if an ALS vehicle is used for a non-emergency transport, but no ALS level service is furnished, the FS portion of the blended payment will be based on the non-emergency BLS level. The amount displayed on the FS for HCPCS Q3020 is the same fee displayed for BLS non-emergency, FS HCPCS A0428. The reasonable charge portion of the blended payment will be the ALS non-emergency rate.

See "Ambulance HCPCS Crosswalk and Definitions" below for a crosswalk of new HCPCS to old HCPCS. For HCPCS Q3019 and Q3020, this crosswalk is relevant for payment purposes only. Old HCPCS codes did not exist for these services.

Only ALS Service Furnished is ALS Assessment

Previously, the policy was established that when an ALS ambulance arrives, an ALS assessment is provided, but no other ALS service is provided, HCPCS code Q3017 was appropriate. This code was to be applicable only during the transition period.

This policy is rescinded. HCPCS code Q3017 has been deleted.

When only an ALS assessment is furnished before the transport, the services should be billed as ALS emergency service A0427 and crosswalked to the appropriate ALS emergency reasonable charge amount.

Subtopics:

• 13.1 Ambulance HCPCS Crosswalk and Definitions (p. 11)
• 13.2 Definitions of Level of Service (p. 12)