2025 HCPCS code A0425
(Active) Effective Date: N/A Revision Date: N/A Transportation - Ground mileage, per statute mile Ambulance and Other Transport Services and Supplies Feed
This HCPCS code represents ground ambulance mileage per mile, covering the distance from patient pickup to destination.
Ambulance origin and destination modifiers (two-digit codes) are used with this code to identify the ambulance's starting and ending points.Specific payer guidelines should be consulted for required modifiers.
Medical necessity is established by the patient's condition requiring emergent or urgent transportation to an appropriate healthcare facility.The ambulance transport should be deemed the safest and most appropriate mode of transportation for the patient's clinical status.
The ambulance service provider is clinically responsible for ensuring the safe and timely transport of the patient.They determine the medically necessary mileage and accurately report it for billing.
In simple words: This code shows how far an ambulance drove with a patient, charging per mile.It only counts the miles while the patient is in the ambulance, from pickup to drop-off.
HCPCS code A0425 represents the ground mileage an ambulance travels with a patient, billed per mile.The ambulance service provider reports the medically necessary loaded mileage only, from patient pickup to arrival at the destination. Unloaded mileage is typically nonreportable. For hard copy claims, mileage is reported in fractional units (rounded to the nearest tenth of a mile).Electronic submissions use whole numbers; fractional miles may be rounded up. Payer-specific coverage and reporting requirements should be verified.
Example 1: A patient experiencing a heart attack is transported 5.2 miles from their home to the nearest hospital. The ambulance service bills 6 units of A0425 (rounded up from 5.2 miles)., An elderly patient falls at home and needs transport to a rehabilitation center 10 miles away.The ambulance service bills 10 units of A0425., A motor vehicle accident victim is transported 2.7 miles from the accident site to the emergency room.The ambulance service bills 3 units of A0425 (rounded up from 2.7 miles).
Documentation should include the patient's pickup location, destination, the total mileage (rounded appropriately for electronic vs. paper claim submission), and medical necessity for transport.Trip records, GPS data, and other supporting documentation may be required.
** Always verify payer-specific requirements for mileage rounding, modifier usage, and documentation needed to support claims.
- Payment Status: Active
- Specialties:Emergency Medical Services, Paramedicine
- Place of Service:Ambulance - Land, Ambulance - Air or Water