Medicare & Medicaid Ambulance Billing
Expert government payer billing that navigates complex CMS requirements and state Medicaid rules to maximize your reimbursement.
Government Payer Expertise for EMS Agencies
Medicare and Medicaid represent the largest revenue source for most ambulance agencies, yet they also carry the most complex billing requirements. CMS updates ambulance fee schedules annually, and each state Medicaid program operates with its own rules.
Our billing specialists maintain current expertise in all government payer requirements — ensuring your claims are clean, compliant, and paid at the maximum allowable rate.
CMS Form 1500 & UB-04 Preparation
Accurate claim form preparation with complete HCPCS coding and medical necessity documentation.
Medicare Advantage Navigation
Specialized handling of Medicare Advantage (Part C) plans, each with unique billing requirements.
State Medicaid Compliance
Up-to-date expertise in Medicaid rules for all 50 states, including prior authorization requirements.
Prior Authorization Support
Assistance obtaining required authorizations for non-emergency transports before claims are submitted.
PECOS Enrollment Assistance
Medicare provider enrollment, revalidation support, and PECOS record maintenance.
Secondary Payer Billing
Coordination of benefits and secondary billing to Medicaid when Medicare is the primary payer.
Medicare & Medicaid Billing FAQ
What does Medicare Part B cover for ambulance services?
Medicare Part B covers ambulance transport when a beneficiary requires medical supervision during transport and alternative means (such as a taxi or private vehicle) would be contraindicated given their medical condition. Coverage includes ground, rotary-wing, and fixed-wing air transport. Medicare pays 80% of the approved amount after the Part B deductible is met.
What HCPCS codes are used for ambulance billing?
Ambulance services use HCPCS Level II codes: A0425 (ground mileage, per statute mile), A0426 (ALS, non-emergency transport), A0427 (ALS1-emergency), A0428 (BLS, non-emergency), A0429 (BLS-emergency), A0430-A0436 (air transport). The level of care must match the services documented in the Patient Care Report (PCR).
How do Medicaid billing requirements differ by state?
Each state runs its own Medicaid program with different coverage rules, prior authorization requirements, reimbursement rates, and claim submission formats. Our team maintains expertise in the Medicaid programs for all states we serve, ensuring accurate and timely claim submission regardless of where your agency operates.
What is PECOS enrollment and why does it matter?
PECOS (Provider Enrollment, Chain, and Ownership System) is the Medicare enrollment system. Ambulance providers must be enrolled in PECOS to bill Medicare. We assist with initial enrollment, revalidation, and updates to your PECOS record to ensure uninterrupted Medicare billing.
Get Expert Medicare & Medicaid Billing Support
Our specialists stay current on all CMS updates and state Medicaid rule changes so you never miss a reimbursement.
Get Your Free Billing Audit