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Ambulance Fee Schedule Public Use Files

CY 2004 – CY 2016:

The AFS public use files for calendar years 2004 through December 31, 2016 are located in the Downloads section below. 

CY 2017:

Beginning with calendar year 2017, the Centers for Medicare & Medicaid Services (CMS) will no longer be creating and publishing an AFS Public Use File (PUF). Instead, CMS will provide and post to this site 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.

Current Legislative Provisions of the Medicare and CHIP Reauthorization Act (MACRA) of 2015 for the three temporary add-on provisions:

Section 203 of the (MACRA of 2015 extended payment provisions of previous legislation including the 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 203 extends the provision increasing Ambulance Fee Schedule amounts by 2% for services originating in urban areas (as defined by the ZIP Code of the point of pickup) and by 3% for services originating in rural areas ( as defined by the ZIP Code of the point of pickup). This provision will expire on December 31, 2017.

Section 203 extends the provision relating to payment for ground ambulance services that increased the base rate for transports originating in an area that is within the lowest 25th percentile of all rural areas arrayed by population density (known as the “super rural” bonus). This provision will expire on December 31, 2017.

Data Elements of the AFS Data File

(1) Carrier:  This is the identifier used by the Centers for Medicare & Medicaid Services 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 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 RVU
BLS (A0428)                           1.00
BLS - Emergency (A0429) 1.60
ALS1 (A0426)  1.20
ALS1- Emergency (A0427) 1.90
ALS2 (A0433)  2.75
SCT (A0434) 3.25
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 2017:

  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 2017:

  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. Medicare contractors 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 the local Medicare Administrative Contractor (MAC).

Disclaimer: The Ambulance Fee Schedule Public Use Files on this page are for informational purposes only. All official fee schedule files that are used to process Medicare claims are maintained by Medicare Administrative Contractors (MACs) and could vary slightly from the amounts referenced in the files below. Contact your local MAC for official pricing information.