2025 HCPCS code A0436
(Active) Effective Date: N/A Revision Date: N/A Transportation - Air Ambulance Mileage Ambulance and Other Transport Services and Supplies Feed
This HCPCS code represents the mileage traveled by a helicopter ambulance transporting a patient.
Modifiers may be applicable depending on the circumstances of the transport (e.g., GY for Medicare non-coverage).
Medical necessity is established based on the patient's condition requiring rapid transport that outweighs the risks and costs associated with ground ambulance transport. Documentation must support the medical necessity of air transport based on factors such as the patient's critical condition, lack of access to alternative transportation, and the need for specialized medical care at a distant facility.
The clinical responsibility rests with the provider transporting the patient, ensuring medically necessary and appropriate transport via helicopter ambulance.
- Ambulance and Other Transport Services and Supplies
- A0021-A0999 (Transportation services including ambulance)
In simple words: This code is for the miles a helicopter ambulance travels to take someone to the hospital or another medical place.Medicare doesn't pay for this, but some state programs might.
HCPCS code A0436 reports the total distance, in miles, covered by a helicopter ambulance during patient transport.This code is used when ground ambulance transport is unsuitable due to the patient's condition or the need for rapid transport.Appropriate destinations include hospitals, critical access hospitals, skilled nursing facilities, dialysis centers, or the patient's home.Medicare does not cover this service; Medicaid coverage varies by state, generally limiting reimbursement to transport to the nearest appropriate facility for necessary diagnostic or therapeutic services.The reimbursement for Medicare patients involves carrier judgment. For transport by airplane, use code A0435.
Example 1: A critically ill patient requires rapid transport from a remote location to a trauma center. A helicopter ambulance is used, and the mileage is reported using A0436., A patient experiencing a stroke needs immediate transfer to a hospital with specialized stroke care. Helicopter transport is chosen, and the mileage is documented with A0436., A patient in a rural area requires transport to a dialysis center for a life-sustaining treatment. Due to the distance and the patient's condition, a helicopter ambulance is used, and A0436 is reported to capture the transport mileage.
Detailed documentation is required, including the patient's condition justifying air transport, the distance traveled, and the destination facility.Supporting documentation may include medical records justifying the need for rapid transport, flight logs detailing the distance covered, and billing information indicating the provider's responsibility.
** Reimbursement for this code is highly variable and depends on the payer, state regulations, and specific circumstances.Always refer to payer-specific guidelines.
- Payment Status: Variable, dependent on payer and circumstances
- Specialties:Emergency Medicine, Critical Care Medicine
- Place of Service:Ambulance - Air or Water