2025 HCPCS code A0431
(Active) Effective Date: N/A Revision Date: N/A Transportation Services - Air Ambulance Transport Ambulance and Other Transport Services and Supplies Feed
Rotary wing air ambulance transport (helicopter) for one-way transport to the nearest appropriate facility for necessary diagnostic or therapeutic services.
Modifiers may be applicable depending on payer requirements and the specific circumstances of the transport.Consult payer guidelines for relevant modifier usage.
Medical necessity for A0431 is established when ground or water ambulance transport is impossible or significantly delays life-saving treatment.The urgency of the situation must be clearly documented.
The clinical responsibility lies with the emergency medical services personnel providing the air ambulance transport and ensuring safe and timely transfer of the patient to the appropriate facility.
In simple words: This code is for a helicopter ambulance ride to the closest hospital or medical facility for urgent medical care.It's only used for one-way trips and only when other ambulances can't get to the patient quickly enough.
This HCPCS code represents a one-way rotary wing air ambulance transport, typically by helicopter, to the nearest appropriate facility for necessary diagnostic and/or therapeutic services.Coverage is limited to the payment amount for bringing the medical care service to the patient.Appropriate facilities may include hospitals, critical access hospitals, skilled nursing facilities, and dialysis facilities.This type of transport is medically necessary when a patient's condition requires immediate transport and other means (ground or water ambulance) are impractical due to distance, traffic, or other obstacles. It may also apply when the patient is inaccessible to other ambulance types.Individual state Medicaid programs may provide non-emergency transportation for covered services.
Example 1: A patient in a remote area suffers a severe stroke.A helicopter ambulance is the only feasible means of transport to a hospital with a stroke center within the critical timeframe for treatment. A0431 is used to bill for this transport., A patient experiences a severe motor vehicle accident in a location inaccessible by ground ambulance due to rugged terrain.Air ambulance transport is necessary to reach the nearest trauma center. A0431 is used to bill for this emergency transportation., A critically ill patient requires immediate transport from a smaller hospital lacking specialized equipment or personnel to a larger tertiary care center.The helicopter transport, facilitated by A0431, is billed for this transfer.
Medical necessity documentation should include:* Patient's condition requiring urgent transport.* Description of why other transport methods were unsuitable (e.g., distance, terrain, traffic).* Documentation of the patient's condition before, during, and after transport.* Destination facility and reason for choosing that location.* Time and date of the transport.
** Reimbursement for A0431 often involves carrier judgment and may vary significantly based on payer policies, geographic location, and the complexity of the transport.
- RVU: Carrier judgment required for Medicare reimbursement.
- Payment Status: Active
- Fee Schedule : Unknown.Reimbursement varies by payer and may involve carrier judgment.
- Specialties:Emergency Medicine, Critical Care Medicine
- Place of Service:Ambulance - Air or Water