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It instructs providers to submit accurate claims supported by correct codes, explains the role of CPT and CMS coding guidelines, and clarifies that reimbursement applies based on documented policy interpretation and regulatory or contract-related factors. The policy also describes ambulance supplier eligibility and origin-destination modifier reporting requirements.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/la-ambulance-policy-reimbursement-policy/362573/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/la-ambulance-policy-reimbursement-policy/362573.png","ImageObject",300,407,{"name":92,"@type":93},"Đào","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-23","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who is responsible for submitting claims under this ambulance reimbursement policy?","Question",{"text":112,"@type":113},"Providers are responsible for submitting accurate claims. Reimbursement depends on codes that correctly describe the health care services provided.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which ambulance suppliers are eligible for reimbursement of ambulance services?",{"text":117,"@type":113},"UnitedHealthcare Community Plan considers only an Ambulance Supplier eligible for reimbursement of services reported with specified HCPCS codes (A0021 and A0225-A0999). Non-Ambulance Suppliers are not reimbursed for rendering ambulance services.",{"name":119,"@type":110,"acceptedAnswer":120},"What are origin and destination modifiers, and how must they be reported?",{"text":121,"@type":113},"For each ambulance trip, the Ambulance Supplier must report an origin and destination modifier based on CMS guidelines. Each modifier uses two single-digit alpha characters: the first for origin and the second for destination, such as RH (residence to hospital).","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},362573,1790459000,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},1374402968488,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Ambulance Policy, Professional for Louisiana  \nIMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY  \nYou are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT® *), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement.  \nThis reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design, and other factors are considered in developing reimbursement policy.  \nThis information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees.  \nOther factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include but are not limited to federal &/or state regulatory requirements, the physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies.  \nFinally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations.  \nUnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication.  \n*CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.  \n\n| Application |\n| --- |\n| This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid products.\u003Cbr>This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. |\n\n\n| Table of Contents |\n| --- |\n| Application\u003Cbr>Policy\u003Cbr>Overview\u003Cbr>Reimbursement Guidelines\u003Cbr>Ambulance Suppliers\u003Cbr>Origin and Destination Modifiers\u003Cbr>Services Included in Ambulance Transportation\u003Cbr>Advanced Life Support, Level 2 (ALS2) Ambulance Transportation\u003Cbr>State Exceptions\u003Cbr>Definitions\u003Cbr>Questions and Answers |\n\nAttachments Resources History  \n\n| Policy |\n| --- |\n| Overview |\n| This policy addresses reimbursement related to services included as part of an ambulance transportation service, ambulance modifier usage, provider specialty reporting ambulance services and the requirements for reporting Advanced Life Support, Level 2 (ALS2) ambulance transportation.\u003Cbr>For purposes of this policy, Same Ambulance Supplier is defined as Ambulance Suppliers of the same specialty reporting the same Federal Tax Identification number (TIN) . |\n| Reimbursement Guidelines |\n| Ambulance Suppliers |\n| UnitedHealthcare Community Plan considers only an Am","cbCaicMSrdJNAQGo","https://ap.wps.com/l/cbCaicMSrdJNAQGo","pdf",233540,"English","# Application\n## Policy\n# Overview\n## Reimbursement Guidelines\n## Ambulance Suppliers\n## Origin and Destination Modifiers\n## Services Included in Ambulance Transportation\n## Advanced Life Support, Level 2 (ALS2) Ambulance Transportation\n## State Exceptions\n# Definitions\n# Questions and Answers","[{\"question\":\"Who is responsible for submitting claims under this ambulance reimbursement policy?\",\"answer\":\"Providers are responsible for submitting accurate claims. Reimbursement depends on codes that correctly describe the health care services provided.\"},{\"question\":\"Which ambulance suppliers are eligible for reimbursement of ambulance services?\",\"answer\":\"UnitedHealthcare Community Plan considers only an Ambulance Supplier eligible for reimbursement of services reported with specified HCPCS codes (A0021 and A0225-A0999). Non-Ambulance Suppliers are not reimbursed for rendering ambulance services.\"},{\"question\":\"What are origin and destination modifiers, and how must they be reported?\",\"answer\":\"For each ambulance trip, the Ambulance Supplier must report an origin and destination modifier based on CMS guidelines. Each modifier uses two single-digit alpha characters: the first for origin and the second for destination, such as RH (residence to hospital).\"}]","LA-Ambulance-Policy - Reimbursement Policy | PDF",1790148349,13]