Ambulance Fee Schedule Public Use Files

These AFS Public Use Files (PUFs) are for informational purposes only. All official fee schedule files that are used to process Medicare claims are maintained by the Medicare Administrative Contractors (MACs) and could vary slightly from the amounts referenced in these files.   Visit your MAC's website for official pricing information.

Expand a menu to view information about the Ambulance Fee Schedule PUFs:

CY 2004 – CY 2023

See the Downloads section below for the AFS public use files for calendar years 2018-2023. For the AFS public use files for calendar years 2004-2017, view archive and legacy files. Note: Since calendar year 2017, we no longer create and publish, as in previous years, an AFS PUF package containing, along with the fee schedule, an index, background information, and the raw data file. Instead, we’ll provide and post to this website a sample data file in Excel “.xls” file format. You can download and use the file to calculate the appropriate Medicare Part B payment rates for Medicare covered ground and air ambulance transportation services.

CY 2023

The Bipartisan Budget Act (BBA) of 2018 includes 3 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.

View the BBA of 2018, summaries of these provisions, and information on the new Medicare Ground Ambulance Data Collection System (GADCS).

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 are set to expire on December 31, 2022. The temporary add-on payments include: 3% 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% 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). The CY 2023 Ambulance PUF does not include these add-on payments.

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 are set to expire on December 31, 2022. The temporary add-on payment includes a 22.6% increase in the base rate for ground ambulance transports that originate in an area that’s within the lowest 25th percentile of all rural areas arrayed by population density (known as the “super rural” bonus). The CY 2023 Ambulance PUF does not include this add-on payment.

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%. The 10% 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 three temporary add-on provisions described above will expire on December 31, 2022 and therefore, are not included in the calculation for the CY 2023 AFS PUF. The CY 2023 AFS PUF is available in the Downloads section below.

Data Elements of the AFS Data File

  1. Contractor: 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 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 (GPCIs).
     
  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.

RVUs

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.

  1. 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.
     
  2. 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).
     
  3. (a) - Urban Base Rate/Urban Mileage

This field displays 1 of 4 rates calculated as such for 2023:

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

See the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100) (PDF) for more information on how we calculate the urban base rate and mileage rate amounts.
 

  1. (b) - Rural Base Rate/Rural Mileage

This field displays 1 of 4 rates calculated as such for 2023:

  1. Rural ground adjusted base rates – (RVU*(.3+ (.7*GPCI)))*BASE RATE* 1.00
  2. Rural air adjusted base rates – ((BASE RATE*.5)+(BASE RATE*.5*GPCI))*RVU*1.5
  3. Rural ground mileage rates – BASE RATE*1.00
  4. Rural air mileage rates – BASE RATE*1.50

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

See the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100) (PDF) for more information on how we calculate the rural base rate and mileage rate amounts.
 

  1. (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. To calculate the “super-rural bonus” payment rate of 22.6%, multiply any rural ground ambulance transport service payment rate by .226.

    The three temporary add-on payment provisions (see 42 CFR § 414.610(c)(1)(ii) and (c)(5)(ii) were effective through December 31, 2022.The provisions above are not included in the calculation for the CY 2023 AFS PUF. 
     
  2. 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.

See 42 CFR § 414.610(c)(5)(i) for more information.

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

Page Last Modified:
11/23/2022 11:28 AM