Skip to Main Content

Ambulance Fee Schedule Public Use Files

Ambulance Fee Schedule (AFS) Public Use Files

CY 2004 – CY 2018:

The AFS public use files for calendar years 2004 through December 31, 2018 are located in the Downloads section below. 

Please note: Beginning with calendar year 2017, the Centers for Medicare & Medicaid Services (CMS) will no longer be creating and publishing, as in previous years, an AFS Public Use File (PUF) “package” containing, along with the fee schedule, an index, background information, and the raw data file. Instead, CMS will provide and post to this website only a sample data file in an Excel “.xls” file format. The file can be downloaded and used to calculate the appropriate Medicare Part B payment rates for Medicare covered ground and air ambulance transportation services.

CY 2019:

The Bipartisan Budget Act (BBA) of 2018 includes three major Medicare ambulance services provisions pertaining to the extensions of certain ground ambulance temporary add-on payments, development of a data collection system for ground ambulance providers and suppliers, and payment reduction for non-emergency ESRD ambulance transports. A copy of the BBA of 2018 and summaries of these provisions are available at: https://www.cms.gov/Center/Provider-Type/Ambulances-Services-Center.html.

Temporary Add-on Payments:

Section 50203 (a) of the BBA of 2018 extended payment provisions of previous legislation including the Medicare and CHIP Reauthorization Act (MACRA) of 2015, Protecting Access to Medicare Act of 2014, the Pathway for SGR Reform Act of 2013, the American Taxpayer Relief Act of 2012, the Middle Class Tax Relief and Job Creation Act of 2012, the Temporary Payroll Tax Cut Continuation Act of 2011, the Medicare and Medicaid Extenders Act of 2010, the Patient Protections and Affordable Care Act of 2010 (ACA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

Section 50203(a)(1) of the BBA of 2018 includes an extension of the temporary add-on payments under section 1834 (l)(13)(A) of the Social Security Act (the Act) that were set to expire December 31, 2017.  They are now extended through December 31, 2022. The temporary add-on payments include: 3 percent increase in the base and mileage rate for ground ambulance services that originate in rural areas (as defined by the ZIP code of the point of pickup and a 2 percent increase in the base and mileage rate for ground ambulance services that originate in urban areas (as defined by the ZIP code of the point of pickup).

Section 50203(a)(2) of the BBA of 2018 includes an extension of the temporary add-on payment  under section 1834 (l)(12)(A) of the Act that was set to expire December 31, 2017.  This add-on payment is now extended through December 31, 2022. The temporary add-on payment includes a 22.6 percent increase in the base rate for ground ambulance transports that originate in an area that is within the lowest 25th percentile of all rural areas arrayed by population density (known as the “super rural” bonus).

Non-Emergency ESRD Ambulance Transports:

Section 53108 of the BBA of 2018 amended Section 1834(l)(15) of the Act pertaining to AFS reductions for non-emergency ESRD ambulance transports.  Effective for ambulance services furnished on or after October 1, 2018 consisting of non-emergency basic life support (BLS) services involving transport of an individual with end-stage renal disease (ESRD) for renal dialysis services furnished other than on an emergency basis by provider of services or renal dialysis facility, this provision increases the reduction in AFS payments from 10 to 23 percent.  The 10 percent reduction applies for ambulance services (as described in section 1834(l)(15) of the Act) furnished during the period beginning on October 1, 2013 and ending on September 30, 2018.

The CY 2019 AFS PUF includes the three temporary add-on payments in the calculation and is available in the downloads section below.

Data Elements of the AFS Data File  

(1) Carrier: This is the identifier used by the CMS to identify the entity which has the responsibility for adjudicating and paying claims within a defined geographical location.

Part A Medicare Administrative Contractors (MACs) pay for ambulance services based on the zip code within the appropriate carrier geographic location.

(2) Locality: This field represents subsets of locations within a defined jurisdiction with different geographic practice cost indices (GPCI’s).

(3) HCPCS: This field lists the associated HCPCS codes that are reported for services payable under the AFS.

(4) Relative Value Units (RVU): RVUs set a numeric value for ambulance services relative to the value of a base level ambulance service. Since there are marked differences in resources necessary to furnish the various levels of ground ambulance services, different levels of payment are appropriate for the various levels of service. The different payment amounts are based on level of service. An RVU expresses the constant multiplier for a particular type of service (including, where appropriate, an emergency response). An RVU of 1.00 is assigned to the Basic Life Support (BLS) level of ground service, i.e., BLS has an RVU of 1; higher RVU values are assigned to the other types of ground ambulance services, which require a higher level of service than BLS.

The RVUs are as follows:

Service Level (HCPCS Code)   RVU
Basic Life Support, Non-emergency (BLS) (A0428) 1.00
Basic Life Support, emergency (BLS- Emergency) (A0429) 1.60
Advanced Life Support, non-emergency, Level 1 (ALS1) (A0426) 1.20
Advanced Life Support, emergency, Level 1 (ALS1- Emergency) (A0427) 1.90
Advanced Life Support, Level 2 (ALS2) (A0433) 2.75
Specialty Care Transport (SCT) (A0434) 3.25
Paramedic Intercept (PI) (A0432) 1.75

Air ambulance services (fixed-wing and rotary) and ground and air mileage have no RVUs. However, on the fee schedule and this public use file the base rate for air ambulance services and ground and air mileage is displayed as an RVU.

(5) Geographic Practice Cost Index (GPCI): The non-facility practice expense (PE) portion of the GCPI of the Medicare physician fee schedule (PFS) is used to adjust payment to account for regional differences. The geographic areas applicable to the AFS are the same as those used for the PFS. 

The location where the beneficiary was put into the ambulance (“point of pickup”) establishes which GPCI applies. For multiple vehicle transports, i.e., where ground ambulance transports to an air ambulance, each leg of the transport is separately evaluated for the applicable GPCI.

Thus, for the second (or any subsequent) leg of a transport, the point of pickup establishes the applicable GPCI for that portion of the ambulance transport. The GPCI is not applied to the mileage payment.

(6) Base Rate: The Base Rate is a nationally uniform dollar amount used to calculate each HCPCS code payment amount, updated annually by the ambulance inflation factor (AIF).

(7)(a)- Urban Base Rate / Urban Mileage: This field displays one of four rates calculated as such for 2019:

  1. Urban ground adjusted base rates – (RVU*(.3+ (.7*GPCI)))*BASE    RATE* 1.02
  2. Urban air adjusted base rates – ((BASE RATE*.5)+(BASE RATE*.5*GPCI))*RVU
  3. Urban ground mileage rates – BASE RATE*1.02
  4. Urban air mileage rates – BASE RATE*1.00

For more information on how the urban base rate and mileage rate amounts are calculated, see the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100).

(7)(b)- Rural Base Rate / Rural Mileage:

This field displays one of four rates calculated as such for 2019:

  1. Rural ground adjusted base rates – (RVU*(.3+ (.7*GPCI)))*BASE  RATE* 1.03
  2. Rural air adjusted base rates – ((BASE RATE*.5)+(BASE RATE*.5*GPCI))*RVU*1.5
  3. Rural ground mileage rates – BASE RATE*1.03
  4. Rural air mileage rates – BASE RATE*1.50

The amount payable for the air base rate and l air mileage rate in a rural area is 1.5 times the urban air base and mileage rate.

For more information on how the rural base rate and mileage rate amounts are calculated, see the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100).

7)(c) - Rural Base Rate / Lowest Quartile:  The “super-rural bonus” payment rate applies only to ground ambulance transports originating in a rural area determined by the Secretary to be in the lowest 25th percentile of all rural populations arrayed by population density. The MACs will apply this amount to the base rate when the point of pickup (POP) is in one of a group of designated rural ZIP codes. In order to calculate the “super-rural bonus” payment rate of 22.6%, multiply any rural ground ambulance transport service payment rate by .226. For example, for HCPCS A0428 (BLS), for Carrier 01112, Locality 05, use the rural rate of $ 286.18 and multiply by .226 for a bonus payment rate (286.18* .226 = 64.68) and then add that bonus rate to the rural rate (286.18 + 64.68 = 350.86.

(8) Rural Ground Miles 1-17 This field displays the amounts for rural ground miles 1-17.

For ground rural miles 1-17, the mileage rate for ground transports provided in a rural area is 1.5 times the rural mileage rate per mile.

(The urban ground mileage rate applies to all miles of an ambulance transport originating in an urban area.)

This field displays a rural amount for the air base rate and air mileage. The amount payable for the base rate and all air miles for all air transportation originating in a rural area is 1.5 times the urban air base and mileage rates.

For more information, please refer to 42 CFR § 414.610(c)(5)(i).

 

Note: For additional information regarding Medicare reimbursement for Medicare covered ambulance transportation services, please contact your local MAC.

Disclaimer: The AFS PUFs on this page are for informational purposes only. All official fee schedule files that are used to process Medicare claims are maintained by the MACs and could vary slightly from the amounts referenced in the files below. Contact your local MAC for official pricing information.

 

 

.