CAC HCPCS Ambulance Service Codes, Transport Levels, and Origin/Destination Modifiers 3

Question 1

According to Medicare guidelines, what minimum personnel qualification is required for ALS Level 1 ambulance transport?

Accepted Answer

At least one EMT-Paramedic or Advanced EMT (AEMT)

Answer

Two EMT-Basics

Answer

One EMT-Basic and one EMT-Intermediate

Answer

Two EMT-Paramedics

Question 2

For ALS Level 2 (A0433) to be appropriately billed, which criteria must be met during transport?

Accepted Answer

Administration of three or more IV medications or at least one ALS2-level procedure

Answer

Use of cardiac monitoring equipment only

Answer

Administration of a single medication IV push

Answer

Transport via air ambulance

Question 3

What is the Medicare medical necessity standard required for ambulance transport to be covered?

Accepted Answer

The patient's condition must be such that transport by other means is contraindicated and ambulance is medically required

Answer

The patient must be in cardiac arrest at time of transport

Answer

A physician must be present in the ambulance

Answer

The transport must be emergent in nature

Question 4

Specialty Care Transport (SCT, A0434) requires which type of medical personnel on board?

Accepted Answer

A specialty care provider such as a critical care nurse or physician beyond paramedic level

Answer

Two certified EMT-Paramedics

Answer

An EMT-Basic with ALS equipment

Answer

A respiratory therapist exclusively

Question 5

Which scenario qualifies as an ALS assessment for ambulance billing purposes even when no ALS intervention is performed?

Accepted Answer

A paramedic performing a medical assessment that determines ALS care is not needed

Answer

Vital signs documented by an EMT-Basic

Answer

Dispatcher documentation of symptom severity

Answer

Automatic defibrillator application only

Question 6

Under Medicare ambulance transport coverage rules, to which facility must a patient typically be transported?

Accepted Answer

The nearest appropriate facility capable of treating the patient's condition

Answer

Any hospital the patient or family selects

Answer

The facility specified by the ambulance company

Answer

A Level I trauma center regardless of distance

Question 7

Which level of service is billed when a paramedic provides care that clearly exceeds ALS Level 1 scope but does not involve specialty care personnel?

Accepted Answer

ALS Level 2 (A0433)

Answer

BLS emergency (A0429)

Answer

ALS Level 1 emergency (A0427)

Answer

Specialty Care Transport (A0434)