HCPCS Code A0422

Official Description

Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation

Short Descr	Ambulance 02 life sustaining
Coverage	Not payable by Medicare
Pricing Indicator(s)	00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI	9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
BETOS	O1A – Ambulance
TOS Code(s)	D – Ambulance
Added Date	1/1/1995
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
MUE	0
MUE	Not applicable/unspecified.
OTS Orthotic	No
CCS Clinical Classification	239 - Transportation - patient, provider, equipment

GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
HH	Integrated mental health/substance abuse program
HN	Bachelors degree level
SH	Second concurrently administered infusion therapy
HR	Family/couple with client present
GW	Service not related to the hospice patient's terminal condition
HE	Mental health program
GN	Services delivered under an outpatient speech language pathology plan of care
HD	Pregnant/parenting women's program
PN	Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
JE	Administered via dialysate
HI	Integrated mental health and intellectual disability/developmental disabilities program
NR	New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased)
RI	Ramus intermedius coronary artery
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76	Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
ED	Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle
EE	Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle
EP	Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program
ET	Emergency services
GA	Waiver of liability statement issued as required by payer policy, individual case
GH	Diagnostic mammogram converted from screening mammogram on same day
GM	Multiple patients on one ambulance trip
GR	This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
HG	Opioid addiction treatment program
HJ	Employee assistance program
HP	Doctoral level
HS	Family/couple without client present
PS	Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy
QL	Patient pronounced dead after ambulance called
QM	Ambulance service provided under arrangement by a provider of services
QN	Ambulance service furnished directly by a provider of services
RD	Drug provided to beneficiary, but not administered "incident-to"
RE	Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems)
RP	Replacement and repair -rp may be used to indicate replacement of dme, orthotic and prosthetic devices which have been in use for sometime. the claim shows the code for the part, followed by the 'rp' modifier and the charge for the part.
RR	Rental (use the 'rr' modifier when dme is to be rented)
SE	State and/or federally-funded programs/services
SN	Third surgical opinion
SS	Home infusion services provided in the infusion suite of the iv therapy provider
TP	Medical transport, unloaded vehicle
U2	Medicaid level of care 2, as defined by each state
U3	Medicaid level of care 3, as defined by each state