In a claim for EMS services, the first modifier after the service code is called the "ambulance modifier" or "location modifier".
Here is a service line from an EMS claim EDI showing the location modifier -- "RJ" in this case -- in its proper position, immediately after the HCPCS code (A0428) and before all procedure modifiers:
LX*1
SV1*HC:A0428:RJ:GY*1500*UN*1***1:2
DTP*472*D8*20150601
REF*6R*AS3N1
A location modifier -- in this example "RJ" -- is made from two individual HCPCS location codes, one for the origin and one for the destination. Here are the location codes to choose from:
- D: Diagnostic or therapeutic site other than "P" or "H"
- E: Residential, domiciliary, or custodial facility (other than an N)
- G: Hospital-based dialysis facility
- H: Hospital
- I: Site of transfer between modes of ambulance transport, such as ground-to-air
- J: Non-hospital dialysis facility
- N: Skilled Nursing Facility (SNF)
- P: Physician's office
- R: Residence
- S: Scene of accident or acute event (valid as an origin, not as a destination)
- W: Treatment in-place or via telehealth (valid for no-transport, but only for certain carriers)
- X: Intermediate stop at physician's office on the way to the hospital (valid as a destination, not as an origin)
For example, a trip from a SNF to dialysis is "NJ". The return trip is "JN".
These code letters are sometimes called "hic-pic codes", or simply "modifiers". You might say "Medicare will pay for transport to an H but not to a P", meaning Medicare will pay for stretcher transport to a hospital but not to a doctor's office.
To learn more about claim EDIs which are also known as 5010s or 837s, read the EDI Primer.
To learn how to code a claim in AngelTrack, visit the Coding Guide.
To learn about the overall workflow of how trips move from dispatch to PCR to QA to billing to coding to claiming to EOBs, visit the Insurance Claims Guide.
Non-Standard Modifiers
The Emergency Triage, Treat, and Transport [ET3] program was an experimental coverage from CMS, by which Medicare will pay for part-B patients to be treated-in-place [TIP] or transported to alternate destinations not normally covered by Medicare.
To this end, the ET3 program introduced new modifiers:
- C: Community mental health center
- F: Federally qualified health center
- O: Physician's office
- U: Urgent care
- W: Treatment in-place or via telehealth, i.e. no transport
These new modifiers are sometimes accepted by state Medicaid carriers, and perhaps by some private carriers. Check their companion guide to find out.
(Note, the ET3 program is now defunct, but it might come back in the future. To learn more about AngelTrack's ET3 integration, read the ET3 Integration Guide.)
Catch-and-Release Claims
Normally, no location modifier will be specified in an EMS claim for which transport did not occur. Medicare does not pay for such "catch and release" services, but some private carriers do.
Of those private carriers which do pay such claims, some impose non-standard requirements on the location modifier. They require either of the following:
- RR: Catch-and-release service provided during a visit to a residence
- SS: Catch-and-release service provided on the scene of an accident
AngelTrack's Coding page understands this requirement, and will allow 'RR' and 'SS' in the location modifier field for any call where transport did not occur.
Treatment-in-Place Claims / G2021 and G2022
Although the ET3 program is now defunct, some state Medicaid carriers adopted ET3-style location modifiers for treatment-in-place:
- EW: Treatment in-place at a residential facility
- RW: Treatment in-place at a residence
- SW: Treatment in-place at the scene of an accident
AngelTrack's Coding page will allow these modifiers for any call that did not result in a transport. You might be required to claim HCPCS code G2021 for this service.
For a claim for a refusal of treatment-in-place, using HCPCS code G2022, you might be required to submit no location modifiers at all.
To learn more about filing claims for treatment-in-place, and for refusals therefrom, please visit the Treat and Release Claims Guide.
Automatic Location Modifiers During Coding
As you code your insurance claims, AngelTrack will attempt to automatically determine the location modifier for you, using information from the dispatch record in question, and from your facility records. Sometimes AngelTrack will provide just half of the modifier (just the origin, or just the destination), in which case the missing half is displayed as a question mark, which you must replace with the correct location modifier.
You can improve AngelTrack's automatic determinations by editing your facility records and specifying each facility's HCPCS location code. It's on the "Billing" tab of the Facility Edit page.
Over time, AngelTrack will fill in any missing HCPCS location codes among your facility records: as you code your claims, AngelTrack will save your chosen location modifier into the dispatch's underlying facility record(s), if they do not yet have their HCPCS location codes configured.
Oscillation of a facility record's HCPCS type
When a biller codes a trip, AngelTrack saves the location modifiers back to the attached facility records, if any.
For example, if a trip from East Nursing Home to South General Hospital gets coded as "NH", then AngelTrack will mark the East Nursing Home facility record as N, and the South General Hospital facility record as H.
This feature can cause a facility record's HCPCS type to oscillate back and forth, if billers are not consistent in their choice of location modifier for trips to and from the facility. If you are experiencing changes in location modifiers, you may have a duplicate record or an inconsistency in your billing process. Such inconsistencies can easily trigger an audit, and we highly recommend aggressively identifying them.