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  • Ambulance Billing Authorization And Privacy Acknowledgment Form Suppliers

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EmergyCare and Corry Ambulance Assignment of Benefits & Privacy Acknowledgement Form *A copy of this form is as valid as an original* Run Date First Name Run# Last Name Standby At: Unit# Crew:.

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Procedure Codes and Modifiers Procedure CodeDescriptionA0420Ambulance waiting time (ALS or BLS), one half (1/2) hour incrementsA0422Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situationA0424Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review)23 more rows

HCPCS code A0429 for Ambulance service, basic life support, emergency transport (BLS-emergency) as maintained by CMS falls under Ambulance and Other Transport Services and Supplies.

HCPCS Code for Specialty care transport (SCT) A0434.

Service Units: For each ambulance trip represented by HCPCS codes A0426, A0427, A0428, A0429, A0433 and A0434 the units of service should be one. The units of service for HCPCS code A0425 should represent the number of loaded miles.

The A0998 code is often used by ambulance services that impose fees for responses that don't result in transport of the patient. This may include fees for patient refusals, “treat and release” and other similar services. Because Medicare is primarily a transport benefit, it doesn't pay for these types of services.

HCPCS Code for Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1) A0426.

Description. A0425. GROUND MILEAGE, PER STATUTE MILE. A0426. AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS 1)

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232