CADS CADS Ambulance Billing & Reimbursement

Question 1

Under Medicare, which level of ambulance service requires documentation of at least one ALS intervention or ALS assessment?

Accepted Answer

ALS Level 1 (ALS1)

Answer

BLS Emergency

Answer

ALS Level 2 (ALS2)

Answer

Specialty Care Transport

Question 2

Which federal regulation governs the Medicare medical necessity requirements for ambulance transport documentation?

Accepted Answer

42 CFR Part 410

Answer

45 CFR Part 164

Answer

29 CFR Part 1910

Answer

21 CFR Part 820

Question 3

What is the primary purpose of the Physician Certification Statement (PCS) in ambulance billing?

Accepted Answer

To certify medical necessity for non-emergency transports

Answer

To document the patient's consent for treatment

Answer

To authorize ALS interventions by paramedics

Answer

To verify insurance eligibility at the time of transport

Question 4

Which modifier is appended to ambulance HCPCS codes to indicate the transport originated at the scene of an accident?

Accepted Answer

SH

Answer

RH

Answer

SE

Answer

SN

Question 5

Under Medicare's ambulance fee schedule, mileage for loaded transport is reimbursed per what unit?

Accepted Answer

Per loaded mile

Answer

Per kilometer

Answer

Per 5-mile increment

Answer

Per transport regardless of distance

Question 6

Which HCPCS modifier combination indicates a transport from a scene to a hospital?

Accepted Answer

SH

Answer

HH

Answer

EH

Answer

SE