EMS Finance

Fixed and Variable Costs

Relative Value Units

ICD and CPT Coding

Ambulance Fee Schedule – Medical Conditions List & Transportation Indicators (PDF)

Medical Necessity

Case Study

You are the employee of a private non-profit rescue squad that provides emergency response coverage for a medium-sized suburban community. Your agency transports most patients to the nearest hospital emergency department. Today you and your partner, both EMTs, are dispatched for a person found unconscious in the park. The park is 2.6 miles from the station. When you arrive, you find a middle-aged man who is housing-insecure. Your assessment reveals he has multiple co-morbid conditions and likely experienced a syncopal episode secondary to dehydration. He asks to be transported, and there are no ALS units available in the area. The patient is calm and cooperative during the 8.2-mile transport. During transport, you do a routine set of diagnostics, including a 12-lead electrocardiogram to investigate cardiac causes of syncope, a blood glucose measurement to investigate diabetic causes of syncope and perform a comprehensive assessment for trauma and other causes of syncope. The patient reports that he has no health insurance. The total time elapsed from dispatch to return to the station was 1 hour.

  1. Was this transport medically necessary?
  2. Syncope is included in ICD-9 code 780.02, “Transient alteration of awareness,” and CMS classifies it as an ALS level call. The transportation indicator “C5” is applied to the call. How much will most payers reimburse for this transport?
    2022 Ambulance Fee Schedule
  3. What are the CPT codes for the procedures performed en route?
    Billing and Coding: Electrocardiograms (93005)
    Billing and Coding: Blood Glucose Monitoring (82948)
  4. What is the difference between what could be charged for the transport by a practitioner and what will be reimbursed by most payers?