Ambulance Reason Code Crosswalk
Published 09/28/2021
Palmetto GBA is currently updating systems to incorporate the standardized Ambulance CMS reason codes and statements. In the interim, please see below list of Palmetto GBA denial codes and the corresponding CMS reason codes and statements. For more information related to CMS reason codes, please refer to the CMS website.
Ambulance Reason Code Crosswalk
| Palmetto GBA Full Denial Code | Palmetto GBA Partial Denial Code | Palmetto GBA Granular Denial Reason | Palmetto GBA Denial Description | CMS Reason Code | CMS Statement |
| Reason Code | Air Ambulance | ||||
| NOMTN | DWNCD | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AM12A | The documentation does not support the beneficiary’s condition was such that transportation by air ambulance was medically reasonable and necessary; basic and / or advanced life support ground ambulance would have been appropriate. Refer to 42 CFR § 410.40, Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.4. |
| Reason Code | Appropriate Facility | ||||
| ATCCF | Transportation is only covered to the closest facility that can provide the necessary care. | Transportation is only covered to the closest facility that can provide the necessary care. | AM200 | The documentation does not support that the more distant facility was the appropriate facility to provide the necessary care. Therefore, the miles beyond the closest facility are denied. Refer to Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.3.6, 10.3.7. | |
| Reason Code | Basic Life Suport (BLS) | ||||
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AM300 | The documentation does not support Basic Life Support services were rendered in event of an emergency response. Refer to 42 CFR § 410.40 (c), 42 CFR § 414.605, Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 20 and Section 30.1.1. | |
| Reason Code | Certification | ||||
| NOPCS | Documentation received lacks the necessary Certificate of Medical Necessity. | No certificate of medical necessity / PCS received. | AMB1F | No physician certification statement submitted for non-emergency, scheduled, repetitive ambulance service. Refer to 42 CFR §410.40 (e)(2). | |
| INPCS | Documentation requested for this date of service was incomplete. | Invalid physician certifcation statement (PCS not signed, incomplete, or invalid). | AMB4D | Missing provider signature on the physician certification statement (non-emergent, scheduled transport). Refer to 42 CFR §410.40 (e)(2). | |
| INPCS | Documentation requested for this date of service was incomplete. | Invalid physician certifcation statement (PCS not signed, incomplete, or invalid). | AMB4E | Incomplete / Invalid provider signature on the physician certification statement (non-emergent, scheduled transport). Refer to 42 CFR §410.40 (e)(2). | |
| INPCS | Documentation requested for this date of service was incomplete. | Invalid physician certifcation statement (PCS not signed, incomplete, or invalid). | AMB4F | Date of service(s) documented on physician certification statement is outside allowed timeframe. Refer to 42 CFR §410.40 (e)(2). | |
| Reason Code | Ground Ambulance: Advanced Life Support (ALS2) Assessment | ||||
| NOMTN | DWNCD | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AM400 | The documentation does not support the requirements of advanced life support, level 2 (ALS2). Documentation does not support the administration of at least 3 separate administrations of one or more medications given by IV push / bolus or continuous infusion or the provision of at least one of the ALS2 procedures (excluding crystalloid fluids) as in the internet Only Manual as in the Internet Only Manual. Refer to 42 CFR § 410.40 (c), 42 CFR § 414.605, Internet Only Manual (IOM), Publication 100- 02, Medicare Benefit Policy Manual, Chapter 10, Section 30.1.1. |
| Reason Code | Ground and Air Ambulance: Beneficiary Death | ||||
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB3B | The documentation supports the beneficiary was pronounced dead prior to dispatch. Refer to Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy, Manual, Chapter 10, Section 10.2.6, 10.4.9. | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB3C | The documentation supports the beneficiary was pronounced dead after dispatch and before being loaded onboard the ambulance, therefore mileage is denied. Refer to Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy, Manual, Chapter 10, Section 10.2.6, 10.4.9. | |
| Reason Code | Hospice | ||||
| NOPRB | Services not covered by Part B Medicare. | Not covered by Part B. | AMB2M | The documentation supports the reason for transport was related to the diagnosis for which the beneficiary is receiving hospice services. The ambulance service may be covered by the Hospice provider. Please submit to the Hospice provider. Refer to SSA 1861 Part E (dd)(1), Internet Only Manual (IOM), Publication 100-02, Chapter 9,Section 40.1.9. | |
| Reason Code | Incorrect Coding | ||||
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB8A | Ambulance claim(s) submitted without valid modifier(s). Refer to Medicare Claims Processing Manual Ch 15, Section 30A. | |
| DNSRP | Information submitted contains an invalid / illegible provider signature. | Invalid signature: Documentation Not Signed by the Rendering Provider. | AMB8B | Billing provider does not match the rendering provider documented in the medical records. | |
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB8C | Ambulance claim(s) submitted with invalid modifier(s) combination. Refer to Medicare Claims Processing Manual Ch 15, Section 30A. | |
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB8Z | Incorrect coding (explain identified problem). | |
| Reason Code | Insufficient Documentation | ||||
| NORUN | Documentation received lacks the necessary Run Report. | Missing or No Run Report received. | AMB1A | The documentation did not contain the ambulance run sheet / trip record. Refer to 42 CFR §410.40 (e), Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.2.4, 10.4.7, Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 15, Section 20.5. | |
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB1B | Patient record submitted does not match patient billed on ambulance claim. | |
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB1C | The origin and destination modifiers billed on the claim do not match the origin and destination modifiers documented on the ambulance run sheet / trip record. Refer to 42.CFR §410.40 (e), Internet Only Manual (IOM), Publication 100-04, Chapter 15, Section 30. | |
| NODOC | Documentation requested for this date of service was not received or was incomplete. | No or partial documentation received. | AMB1D | The service billed was not documented in the patient medical record for this ambulance transport. | |
| NODOC | Documentation requested for this date of service was not received or was incomplete. | No or partial documentation received. | AMB1E | Dispatch status to support service billed was not documented in patient medical record for this service. | |
| BNSIG | Documentation received lacks the necessary beneficiary or authorized representative signature. | Lack or absence of a beneficiary signature. | AMB1H | The service is denied as the beneficiary refused to sign for the transport or consent. | |
| NODOC | Documentation requested for this date of service was not received or was incomplete. | No or partial documentation received. | AMB1Z | Insufficient Documentation (explain identified problem). | |
| NODOC | Documentation requested for this date of service was not received or was incomplete. | No or partial documentation received. | AMB1X | No documentation received. | |
| Reason Code | Locality | ||||
| ATCCF | Transportation is only covered to the closest facility that can provide the necessary care. | Transportation is only covered to the closest facility that can provide the necessary care. | AM500 | The documentation does not support the facility was within the locality to which the ambulance service would normally travel or is expected to travel to receive services. Refer to Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.3.5. | |
| Reason Code | Medical Necessity — Provider Liable | ||||
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB3A | Transport Not Medically Necessary without an Advance Beneficiary Notice (ABN). Refer to Internet Only Manual, Pub 100-4, Medicare Claims Processing Manual, Chapter 30, Section 50. | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB3Z | Medical necessity (explain identified problem). | |
| ASAVA | Alternative services were available and should have been utilized. | Alternative services were available and should have been utilized. | AMB2I | The documentation does not indicate that transportation by another means is contraindicated. Alternative transport services should have been utilized whether or not they were available. Refer to SSA 1861 (s)(7), 42 CFR §410.40 (e), Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.2.1, 20, and Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 15, Section 10.2. | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB3E | The documentation does not support the ambulance service was medically necessary and reasonable. Refer to SSA 1861 (s)(7), 42 CFR §410.40 (e), Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.2, 20, Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 15, Section 10.2. | |
| NOMTN | DWNCD | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB3F | The documentation does not support the ALS level of service furnished was medically necessary. The services will be allowed at a BLS level of service. Refer to SSA 1861 (s)(7), 42 CFR §410.40, Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.2.2, 20, 30.1.1. |
| Reason Code | Miles | ||||
| INMIL | Documentation received contains incorrect / incomplete / invalid mileage. | Incorrect / Incomplete / Invalid mileage (use when denying partial mileage). | AMB1I | The documentation does not support the mileage billed. Refer to 42 CRF § 410.41 (c), Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.3, 10.4, 10.4.1, Internet Only Manual (IOM), Publication 100-04. Medicare Claims Processing Manual, Chapter 15, Section 20.2. | |
| INMIL | Documentation received contains incorrect / incomplete / invalid mileage. | Incorrect / Incomplete / Invalid mileage (use when denying partial mileage). | AMB5A | The documentation does not support the beneficiary was onboard the ambulance to support the total miles billed. Refer to SSA 1861 (s)(7), 42 CFR §410.40 (e), Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.2.5, Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 15, Section 10.2. | |
| Reason Code | Origin / Destination Related | ||||
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB6A | Non-payable origin / destination modifiers billed (scheduled service such as physician office to beneficiary's residence; potential public health emergency exceptions). Refer to 42 CFR §410.40, Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 15, Section 30. | |
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB6Z | Origin / destination related (explain identified problem). | |
| Reason Code | Other | ||||
| NOPRB | Services not covered by Part B Medicare. | Not covered by Part B. | AM11A | Claim / service not covered by this payer / contractor. You must send the claim / service to the correct payer / contractor. | |
| NOMTN | DWNCD | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AM11B | This claim was adjusted after records were reviewed and it was determined that the documentation did not support the level of service billed on the claim (i.e., recoding the ambulance service to the level of care that reflects the services rendered, or down coding services when the title of the emergency personnel cannot be validated). |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB2A | Facility to facility transport denied as the documentation supports that the discharging institution was not an appropriate facility. | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB2B | This hospital to hospital transport is denied as the patient was already at a facility able to provide the necessary services. | |
| NOPRB | Services not covered by Part B Medicare. | Not covered by Part B. | AMB7Y | Amb billed during an inpatient stay are included in the facility’s PPS payment and are not separately payable under Part B. | |
| Reason Code | Signatures | ||||
| BNSIG | Documentation received lacks the necessary beneficiary or authorized representative signature. | Lack or absence of a beneficiary signature. | AMBIG | The documentation does not contain the signature of the beneficiary, or that of his or her representative (for both the purpose of accepting assignment and submitting a claim to Medicare) was obtained prior to submitting the claim. Refer to 42 CFR. | |
| ISIGN | Information submitted contains an invalid / illegible provider signature. | Invalid signature. | AMB4B | Missing / Incomplete / Invalid ambulance supplier signature on ambulance record or invalid or no response to signature attestation. Refer to Internet Only Manual (IOM) Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4. | |
| Reason Code | Destination | ||||
| ATCCF | Transportation is only covered to the closest facility that can provide the necessary care. | Transportation is only covered to the closest facility that can provide the necessary care. | AMB2C | Facility to facility transport denied as the documentation does not support that the receiving institution was the closest facility. | |
| ATCCF | Transportation is only covered to the closest facility that can provide the necessary care. | Transportation is only covered to the closest facility that can provide the necessary care. | AMB2D | The documentation does not support the ambulance transport was to the nearest appropriate facility that can provide the necessary care. Refer to SSA 1861 (s)(7), 42 CFR §410.40 (f), Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, Section 10.3, and Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 15, Section 10.2. | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB2E | Facility to facility transport denied as documentation indicates transport due to physician and / or beneficiary preference. | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB2F | Facility to facility transport denied as documentation indicates transport due to beneficiary wants to be closer to home or family. | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB2H | Ambulance service to a funeral home is not covered. | |
| Reason Code | Does Not Meet Benefit (Non-clinical) | ||||
| BNSIG | Documentation received lacks the necessary beneficiary or authorized representative signature. | Lack or absence of a beneficiary signature. | AMB4A | Missing / incomplete / invalid patient signature or authorized representative signature on ambulance consent. | |
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB4C | Missing / Incomplete / invalid date on ambulance record. | |
| WRONG | Documentation received contains incorrect / incomplete / invalid patient identification or date of service. | Inconsistent information; Wrong patient or Wrong DOS. | AMB4G | Date of service(s) documented does not match date of service(s) (DOS) billed on ambulance claim. | |
| NODOC | Documentation requested for this date of service was not received or was incomplete. | No or partial documentation received. | AMB4X | Services billed were not rendered. | |
| Reason Code | Does not meet definition of Medicare Ambulance Benefit — Beneficiary Liable | ||||
| BNSIG | Documentation received lacks the necessary beneficiary or authorized representative signature. | Lack or absence of a beneficiary signature. | AMB2J | This service is denied as the beneficiary refused transport. | |
| NOPRB | Services not covered by Part B Medicare. | Not covered by Part B. | AMB2K | Non-covered charge(s). | |
| NOPRB | Services not covered by Part B Medicare. | Not covered by Part B. | AMB2L | Statutorily excluded service(s). | |
| NOMTN | Payer deems the information submitted does not support medical necessity of services billed. | Documentation does not support medical necessity. | AMB2N | Transport Not Medically Necessary with an Advance Beneficiary Notice (ABN). Refer to Internet Only Manual, Pub 100-4, Medicare Claims Processing Manual, Chapter 30, Section 50. | |
| NOPRB | Services not covered by Part B Medicare. | Not covered by Part B. | AMB2Z | Does not meet definition of Medicare ambulance benefit (explain identified problem). |