Understanding Origin and Destination Codes in Ambulance Billing

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Understanding Origin and Destination Codes in
Ambulance Billing
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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. Thats 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

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Understanding Origin and Destination Codes in
Ambulance Billing

• J Freestanding ESRD facility
• N Skilled nursing facility
• P Physicians office
• R Residence
• S Scene of accident or acute event
• X Intermediate stop at physicians 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
• Physicians Office
• U Urgent Care Facility
• W Treatment in Place (in person or via
  telehealth)

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Understanding Origin and Destination Codes in
Ambulance Billing

• 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.

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Understanding Origin and Destination Codes in
Ambulance Billing
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 info_at_legionhealthcaresolutions.com
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