Home > Claims, Coding, Payment
Web Content Viewer
Web Content Viewer
Non-emergency ground ambulance transports covered temporarily
April 20, 2020

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.

  • Applies to in-network, ground ambulance providers for HMO, PPO, Indemnity, Medicare Advantage, and Federal Employee Program* members
  • Excludes air ambulance transport
  • Notification is not required
  • Cost share is waived for members with a COVID-19 diagnosis
  • Cost share will apply to members without a COVID-19 diagnosis.

How to bill for ambulance transport

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.

Modifier Description
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.

MPC_030620-1N-28