This article is for acute care facilities, ambulance service suppliers, dialysis facilities, extended care facilities, home health agencies, long term care hospitals, rehabilitation hospitals, and urgent care centers caring for our members
For the duration of the Massachusetts health emergency, we will waive pre-authorization requirements for ground ambulance transport by a contracted provider. In addition, ground ambulance transport to and from the locations listed below will be covered to help our healthcare delivery system optimize inpatient capacity.
Be sure to bill using CPT A0426, A0428, A0433, or A0434 (non-emergent transports) and the appropriate modifier shown below to represent the direction of the transfer.
August 18, 2020 update: The modifiers NJ and JN were added to the table below. Refer to our August 18, 2020 news article for this update.
|DH||Diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital) to hospital|
|EH||Residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiary’s home to hospital|
|HD||Hospital to diagnostic site (including COVID-19 testing) or therapeutic site (including dialysis; excluding physician office or hospital)|
|HE||Hospital to residential, domiciliary, custodial facility (other than skilled nursing facility) if the facility is the beneficiary’s home|
|HH||Hospital to hospital (includes ASCs approved to provide hospital level of care)|
|HN||Hospital to alternative site for skilled nursing facility (SNF)|
|HR||Hospital to residence|
|JN*||Freestanding end-stage renal disease (ESRD) facility to skilled nursing facility|
|NH||Alternative site for SNF to hospital|
|NJ*||Skilled nursing facility to freestanding end-stage renal disease (ESRD) facility|
|NN||SNF to SNF|
|NR*||SNF to residence|
|PD||Physician office to community mental health center, federally qualified health center, rural health center, urgent care facility, non-provider-based ambulatory surgical center or freestanding emergency center, or location furnishing dialysis services that is not affiliated with an end-stage renal facility|
|PE*||Physician office to residential, domiciliary, custodial facility (other than skilled nursing) if the facility is the beneficiary’s home|
|PH||Physician office to hospital|
|PR*||Physician office to home|
|RH||Residence to hospital|
|RN*||Residence to SNF|
*These modifiers do not apply to Federal Employee Program members.