Ambulance Services

Billing and Reimbursement
Policy Number: RP-P-010

Last Updated: Jan. 18, 2022 

BCBSNE Ambulance policy follows CMS ambulance billing guidelines, including but not limited to, content denials, origin-destination modifiers and frequency edits.

Ambulance (Hospital-Based) 

Submit hospital-based helicopter, fixed-wing and ground ambulance charges separately on a UB04 claim form with the appropriate Level II HCPCS Codes. Hospital-based providers shall bill BCBSNE directly for these services, regardless of patient destination. Air ambulance providers must file claims to the Blue Plan in whose service area the point of pick-up occurred based on ZIP code.  

Claims will be rejected if:

  • There is no point-of-pickup zip code listed 
  • The point-of-pickup zip code is not in the BCBSNE service area   
  • Multiple zip codes are listed   
  • The zip code submitted does not comply with the required format  

Note: This change does not apply to hospital-based air ambulance services billed on a UB-04 under a hospital’s tax ID number and NPI.  

Ambulance Mileage 

Ambulance transport is only covered to the nearest appropriate facility. Report non-covered miles with appropriate code in the Units field.    

An example of non-covered miles would be when the patient requests to be transported beyond the nearest appropriate facility. For hospital-to-hospital transfers, please indicate why the transfer was necessary (e.g., “transportation for specialized care”). Claims that do not contain this information will be returned. For non-emergent transports, please include information on why ambulance transport was necessary.

Ambulance (Non-hospital-based) 

A hospital may not bill charges from an ambulance provider for a patient brought to their facility. Ambulance providers shall bill BCBSNE directly for these services on the CMS 1500 claim form.