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Ambulance Billing Lifetime Authorization and Privacy Acknowledgment Form Patient Name: Transport Date: I request that payment of authorized Medicare, Medicaid, or any other insurance benefits be made.

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HCPCS code A0425 for Ground mileage, per statute mile as maintained by CMS falls under Ambulance and Other Transport Services and Supplies.

Emergency Call Use HCPCS code A0427 (ambulance service, advanced life support, emergency transport, level 1 [ALS1-emergency]) or A0429 (ambulance service, basic life support, emergency transport [BLS-emergency]) when billing for response to an “emergency” (911) call.

An ambulance bill is a service invoice delivered to a patient by a healthcare facility asking for payment for expenditures related to EMS services. An ambulance provides out-of-hospital medical care and transportation ranging from essential to advanced life support.

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

Article - Billing and Coding: Ambulance Services (Ground Ambulance) (A54574)

Transportation Services Including Ambulance, Medical & Surgical Supplies CodeDescriptionA0429Ambulance service, basic life support, emergency transport (bls-emergency)A0430Ambulance service, conventional air services, transport, one way (fixed wing)242 more rows

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

SCT (procedure code A0434) is the interfacility transport of a critically injured or ill client by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the emergency medical technician (EMT) or paramedic.

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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