Understanding Origin and Destination Codes in Ambulance Billing
An important ambulance billing best practice is knowing how to code ambulance transport origins and destinations properly. When it comes to identifying proper origin and destination codes in medical billing, it is a common practice to follow the Centers for Medicare and Medicaid (CMS) guidelines for ambulance billing, given most commercial carriers have adopted these guidelines as well. That’s why we referred CMS document to explain origin and destination codes in ambulance billing.
Origin and Destination Codes in Ambulance Billing
For ambulance service claims, institutional-based providers and suppliers must report origin and destination codes for each ambulance trip. Origin and destination codes used for ambulance services are created by combining two alpha characters. Each alpha character, with the exception of “X”, represents an origin code or a destination code. The pair of alpha codes creates one code to be reported in modifier field. The first position alpha code equals origin; the second position alpha code equals destination. The Centers for Medicare & Medicaid Services (CMS) maintains the list of valid codes. Origin and destination codes and their descriptions are as follows:
- D = Diagnostic or therapeutic site other than P or H when these are used as origin codes;
- E = Residential, domiciliary, custodial facility (other than 1819 facility);
- G = Hospital based ESRD facility;
- H = Hospital;
- I = Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport;
- J = Freestanding ESRD facility;
- N = Skilled nursing facility;
- P = Physician’s office;
- R = Residence;
- S = Scene of accident or acute event;
- X = Intermediate stop at physician’s office on way to hospital (destination code only)
While combinations of these items may duplicate other HCPCS modifiers, when billed with an ambulance transportation code, the reported modifiers can only indicate origin/destination. Beginning with start date of the ET3 Model on January 1, 2021 (and only for as long as the CMS ET3 Model is in effect), CMS is allowing the following alpha character modifiers to be used in the “destination” position of the origin/destination modifier combination on Emergency Triage, Treat, and Transport (ET3) Model ambulance claims to indicate, an allowable alternative destination; or in the case of the beneficiary being treated in place (no transport of the beneficiary occurs):
- C = Community Mental Health Center;
- F = Federally Qualified Health Center;
- = Physician’s Office;
- U = Urgent Care Facility;
- W = Treatment in Place (in person or via telehealth)
Note that these new destination codes are to be used on ET3 Model ambulance claims only and shall not be used, in any circumstance, in the origin code position of an ambulance service line HCPCS origin/destination modifier combination. These codes are only to be used by selected ET3 Model Participants.
Emergency Triage, Treat, and Transport (ET3) Model
Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call. CMS will continue to pay to transport a Medicare FFS beneficiary to a hospital emergency department or other covered destination. In addition, under the model, CMS will pay participants to
- transport to an alternative destination partner, such as a primary care office, urgent care clinic, or a community mental health center (CMHC), or
- initiate and facilitate treatment in place with a qualified health care partner, either at the scene of the 911 emergency response or via telehealth.
The model will allow beneficiaries to access the most appropriate emergency services at the right time and place. As a result, the ET3 Model aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.
Legion Healthcare Solutions is a leading medical billing company providing complete billing and coding services. We can help you in receiving timely and accurate reimbursements for ambulance services. To know more our billing and coding services, contact us at 727-475-1834 or email us at email@example.com
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