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February 14, 2013

Ambulance: Results of Progressive Corrective (PCA) for Ambulance HCPCS Code A0427

HCPCS code A0427: Ambulance service, advanced life support, emergency transport, level 1 (ALS1-emergency)

CGS conducted probe reviews on ambulance providers in Ohio and Kentucky that submitted claims for HCPCS code A0427 (ALS1- emergency). Based on our review of 110 claims, we identified the following issues:

  • In some cases, documentation supported a BLS level of transport (HCPCS code A0429), not ALS.
  • Claims did not include the beneficiary's signature (or the signature of his or her authorized representative), in accordance with guidelines in the CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter10, section 20.1.2.
  • Some ambulance transports did not meet medical necessity requirements, as the patients' medical conditions did not warrant transportation by ambulance. The patients could have been safely transported by other means.

CGS has provided education to providers that were impacted, and we have begun the process of collecting any identified overpayments.

For more information on Medicare guidelines for ambulance services, please refer to:

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