Ambulatory Billing Services
Prospect Healthcare Solutions provides ambulance billing services for private EMS companies, fire-based and municipal EMS agencies, and hospital-based transport teams. We turn patient care reports into clean claims: the right level of service, loaded mileage, origin and destination modifiers, and the medical necessity documentation payers ask for.
Ambulance claims are denied for reasons other services rarely see, such as a missing physician certification statement, a transport level the run report doesn’t support, or a repetitive non-emergency trip without prior authorization. We check each of these before a claim goes out, then work every denial until it’s paid or closed.
What Our Ambulance Billing Covers
- Run report review: we read the patient care report (ePCR) to confirm the level of service, the patient’s condition and why other transport wasn’t safe.
- Coding: HCPCS level-of-service and mileage codes, origin and destination modifiers, and ICD-10 codes from the crew’s documentation.
- Insurance and demographics: finding and verifying coverage for patients transported without insurance details.
- Medicare paperwork: physician certification statements and prior authorization for repetitive non-emergency transports.
- Claims, payment posting, denials and appeals for Medicare, Medicaid and commercial payers.
- Patient billing that follows federal and state balance-billing rules.
- Reporting on collections, denials and AR by payer and transport type.
Why Choose Our Ambulance Billing Services
Accurate Level of Service
We code each trip at the level the run report supports, from BLS and ALS1 to ALS2 and specialty care transport, so claims aren't downcoded or denied.
Mileage and Modifiers
Loaded mileage is billed to the tenth of a mile, with the origin and destination modifier pair that matches the trip.
PCS and Prior Authorization
We track physician certification statements and Medicare prior authorization for repetitive scheduled non-emergency transports before trips are billed.
Denial Management
Every denial is worked by its reason code, corrected or appealed with the run report, and tracked so the same error stops repeating.
Compliance
Documentation-based coding, HIPAA-compliant handling of patient records and billing that follows Medicare ambulance rules.
Clear Reporting
Monthly reports on collections, denials and AR by payer and transport type, so you see where revenue is held up.
Ambulance Billing Rules We Handle
Level-of-Service and Mileage Codes
Ground transports bill one level-of-service code (A0426–A0429 for ALS and BLS, A0433 for ALS2, A0434 for specialty care transport) plus A0425 for loaded mileage. Air transports use A0430 or A0431 with A0435 or A0436 for air mileage. The level billed has to match the care documented, not just the vehicle that was sent.
Origin and Destination Modifiers
Every ambulance claim carries a two-letter modifier for where the trip started and ended, such as RH for residence to hospital or SH for scene of an accident to hospital. A wrong or missing pair is one of the most common reasons ambulance claims are rejected.
Medical Necessity and the PCS
Medicare pays only when other transport would have endangered the patient. The run report has to show why. For scheduled non-emergency trips, Medicare also requires a physician certification statement (PCS) signed by the attending physician.
Prior Authorization for Repetitive Transports
Medicare requires prior authorization nationwide for repetitive scheduled non-emergency transports billed with A0426 or A0428: three or more round trips in 10 days, or at least one round trip a week for three weeks. Common examples are dialysis and wound care trips.
Out-of-Network and Surprise Billing Rules
The federal No Surprises Act does not cover ground ambulances, but many states have their own limits on balance billing patients. We bill patient balances in line with the rules of each state you operate in.
Timely Filing and Follow-Up
Medicare claims must be filed within 12 months of the transport date, and commercial deadlines are often shorter. We submit claims promptly and follow up on every open claim before its deadline.
Continuous Support
Our billing team answers questions about claims, appeals and patient balances, and works with your crews on documentation gaps that cause denials.
Ambulance Billing FAQs
What do ambulance billing services include?
Run report review, level-of-service and mileage coding, origin and destination modifiers, insurance verification, physician certification statements, prior authorization, claim submission, payment posting, denial management and patient billing.
What HCPCS codes are used for ambulance billing?
Ground transports use one level-of-service code (A0426 to A0429, A0433 or A0434) plus A0425 for loaded mileage. Air transports use A0430 or A0431 with A0435 or A0436 for air mileage.
What are ambulance origin and destination modifiers?
Two-letter modifiers that show where a trip started and ended, such as RH for residence to hospital or SH for scene of an accident to hospital. Every ambulance claim needs one.
Does Medicare require prior authorization for ambulance transports?
Yes, for repetitive scheduled non-emergency transports billed with A0426 or A0428: three or more round trips in 10 days, or at least one round trip a week for three weeks.
What is a physician certification statement (PCS)?
A form signed by the attending physician confirming that ambulance transport was medically necessary. Medicare requires it for scheduled non-emergency transports.
Does the No Surprises Act apply to ground ambulances?
No. The federal law does not cover ground ambulances, but many states have their own limits on balance billing patients.
Who We Bill For
We bill for private ambulance companies, fire-based and municipal EMS, hospital-based transport services and interfacility transport providers. Whether you run emergency 911 calls, scheduled dialysis transports or critical care transfers, we apply the payer rules for each transport type. Need help with credentialing a new service area? See our credentialing services, or contact us to talk through your billing.