US · guidance
CMS Pub. 100-04, ch. 19, § 100.12.1.1
A/B MAC (A) - Outpatient Hospital-Based Ambulance
Services - Medicare Part B - Claims Processing
(Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06)
Outpatient ambulance bills from hospital-based ambulance providers are submitted with
revenue code 054X (ambulance) with charges for ambulance, as well as the appropriate
ambulance HCPCS codes on TOB 12X or 13X.
If an outpatient encounter occurs at the same time a covered ambulance service is
provided, the hospital-based ambulance providers may bill for a clinic visit (revenue code
051X) as well as the ambulance charges (revenue code 054X) and will be paid separately
for each service.
The MSN is suppressed.
History
(Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7fab84c6cdcd1515719bc532b5d177201840a31d82d35336dd434cff160e3749
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