Ambulance Mileage

Ambulance mileage services under the prior authorization, HCPCS code A0425, have been originally paid in error when the transport for the same date of service was denied for prior authorization coverage. Providers should refund the payment upon receipt of the overpayment letter that will be sent as mass adjustments are periodically performed. This applies to Jurisdictions J and M.

The criteria for these adjustments are as follows:

• HCPCS code A0425 paid when the associated transport was denied
• The mileage services were denied with the CARC/RARC to match the transport denial (the denial on the adjustments has a different CARC and MSN from the denials)

Both services stay on the same claim since this scenario is based on a denied transport code. Services are only split into another claim if a rejection is involved.

Since the mileage is paying in error due to a system limitation, mass adjustments are made periodically to request that payment back as it is an overpayment.

This system limitation affects all Medicare Administrative Contractors (MACs) processing RSNAT claims.