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HCPCS Range Ambulance and Other Transport Services and Supplies

• 1 Ambulance service, outside state per mile, transport (Medicaid only) ( A0021 )

• 2 Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest ( A0080 )

• 3 Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest ( A0090 )

• 4 Non-emergency transportation; taxi ( A0100 )

• 5 Non-emergency transportation and bus, intra or inter state carrier ( A0110 )

• 6 Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems ( A0120 )

• 7 Non-emergency transportation: wheel-chair van ( A0130 )

• 8 Non-emergency transportation and air travel (private or commercial) intra or inter state ( A0140 )

• 9 Non-emergency transportation: per mile - case worker or social worker ( A0160 )

• 10 Transportation ancillary: parking fees, tolls, other ( A0170 )

• 11 Non-emergency transportation: ancillary: lodging-recipient ( A0180 )

• 12 Non-emergency transportation: ancillary: meals-recipient ( A0190 )

• 13 Non-emergency transportation: ancillary: lodging escort ( A0200 )

• 14 Non-emergency transportation: ancillary: meals-escort ( A0210 )

• 15 Ambulance service, neonatal transport, base rate, emergency transport, one way ( A0225 )

• 16 BLS mileage (per mile) ( A0380 )

• 17 BLS routine disposable supplies ( A0382 )

• 18 BLS specialized service disposable supplies; defibrillation (used by ALS ambulances and BLS ambulances in jurisdictions where defibrillation is permitted in BLS ambulances) ( A0384 )

• 19 ALS mileage (per mile) ( A0390 )

• 20 ALS specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in BLS ambulances) ( A0392 )

• 21 ALS specialized service disposable supplies; IV drug therapy ( A0394 )

• 22 ALS specialized service disposable supplies; esophageal intubation ( A0396 )

• 23 ALS routine disposable supplies ( A0398 )

• 24 Ambulance waiting time (ALS or BLS), one half (1/2) hour increments ( A0420 )

• 25 Ambulance (ALS or BLS) oxygen and oxygen supplies, life sustaining situation ( A0422 )

• 26 Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review) ( A0424 )

• 27 Ground mileage, per statute mile ( A0425 )

• 28 Ambulance service, advanced life support, non-emergency transport, level 1 (ALS 1) ( A0426 )

• 29 Ambulance service, advanced life support, emergency transport, level 1 (ALS 1-emergency) ( A0427 )

• 30 Ambulance service, basic life support, non-emergency transport, (BLS) ( A0428 )

• 31 Ambulance service, basic life support, emergency transport (BLS-emergency) ( A0429 )

• 32 Ambulance service, conventional air services, transport, one way (fixed wing) ( A0430 )

• 33 Ambulance service, conventional air services, transport, one way (rotary wing) ( A0431 )

• 34 Paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers ( A0432 )

• 35 Advanced life support, level 2 (ALS 2) ( A0433 )

• 36 Specialty care transport (SCT) ( A0434 )

• 37 Fixed wing air mileage, per statute mile ( A0435 )

• 38 Rotary wing air mileage, per statute mile ( A0436 )

• 39 Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) ( A0888 )

• 40 Ambulance response and treatment, no transport ( A0998 )

• 41 Unlisted ambulance service ( A0999 )