CMS Pub. 100-04, ch. 15, § 20.6

Section 637 of the American Taxpayer Relief Act of 2012 requires that, effective for transports

occurring on and after October 1, 2013, fee schedule payments for non-emergency basic life

support (BLS) transports of individuals with end-stage renal disease (ESRD) to and from renal

dialysis treatment be reduced by 10%. The payment reduction affects transports (base rate and

mileage) to and from hospital-based and freestanding renal dialysis treatment facilities for

dialysis services provided on a non-emergency basis. Non-emergency BLS ground transports

are identified by Healthcare Common Procedure Code System (HCPCS) code A0428.

Ambulance transports to and from renal dialysis treatment are identified by modifier codes “G”

(hospital-based ESRD) and “J” (freestanding ESRD facility) in either the first position (origin

code) or second position (destination code) within the two-digit ambulance modifier. (See

Section 30 (A) for information regarding modifiers specific to ambulance.)

Effective for claims with dates of service on and after October 1, 2013 through September 30,

2018, the 10% reduction will be calculated and applied to HCPCS code A0428 when billed with

modifier code “G” or “J”. The reduction will also be applied to any mileage billed in association

with a non-emergency transport of a beneficiary with ESRD to and from renal dialysis treatment.

BLS mileage is identified by HCPCS code A0425.

The 10% reduction will be taken after calculation of the normal fee schedule payment amount,

including any add-on or bonus payments, and will apply to transports in rural and urban areas as

well as areas designated as “super rural”.

Payment for emergency transports is not affected by this reduction. Payment for non-emergency

BLS transports to other destinations is also not affected. This reduction does not affect or change

the Ambulance Fee Schedule.

Note: The 10% reduction applies to beneficiaries with ESRD that are receiving non-emergency

BLS transport to and from renal dialysis treatment. While it is possible that a beneficiary who is

not diagnosed with ESRD will require routine transport to and from renal dialysis treatment, it is

highly unlikely. However, contractors have discretion to override or reverse the reduction on

appeal if they deem it appropriate based on supporting documentation.

Section 53108 of the Bipartisan Budget Act of 2018 increased the amount of the reduction

described above to 23% for transports occurring on and after October 1, 2018.