Ambulance Billing Reminder


Dear Ambulance Provider,

This notice is to remind ambulance providers about how to submit their claims to the Health Care Authority. Please note the following:

  • Round mileage up to the nearest whole number. For fee-for-service claims submitted to the Health Care Authority, fractional mileage must be rounded up to the nearest whole number (e.g. 27.2 miles must be entered as 28).  
  • Origin and destination modifiers are required on all codes. Providers must use a combination of two characters to identify origin and destination (e.g., A0428 NH, A0425 NH). The first character indicates the transport’s place of origin. The destination is indicated by the second character. These modifiers are to be entered in field 24D on the CMS-1500 claim form. Effective January 1, 2016, any claim submitted without the proper origin and destination modifiers will be denied.