016-06-06 Ark. Code R. § 76
93041* | A0380 | A0382 | A0390 | A0398 | A0422 | A0426 | A0427 |
A0429 | J0150* | J0170* | J0280* | J0460* | J1094* | J1100* | J1160* |
J1200* | J1940* | J2060* | J2175* | J2270* | J2310* | J2550* | J2560* |
J3360* | J3410* | J3475* | J3480* | J3490* | Q4076* |
*Procedure code can be billed only in conjunction with procedure code A0427 .
Procedure Code | Required Modifier | Description |
A0436 | Emergency, per mile, loaded, helicopter air ambulance | |
A0422 | U1 | Emergency, oxygen, helicopter air ambulance |
A0431 | Ambulance service, emergency, basic pick-up, helicopter, one unit per day | |
A0428 | Ambulance service, ILS intermediate transport, mileage and disposable supplies billed separately | |
A0380 | TF | ILS mileage (per mile) |
T2002** | Non-emergency ground ambulance transportation, hospital to nursing facility | |
A0435 | U1, UB | Piston propelled fixed wing air ambulance per mile |
U2, UB | Turboprop fixed wing air ambulance per mile | |
U3, UB | Jet (fixed wing) one unit equals one mile | |
U4, UB | Piston propelled fixed wing air ambulance per hour (Round to the nearest hour.) | |
U5, UB | Turboprop fixed wing air ambulance per hour (Round to the nearest hour.) | |
U6, UB | Jet (fixed wing) one unit equals one hour (Round to the nearest hour.) | |
A0434 | Air Ventilator/Respiratory Therapist, one unit equals one hour (Round to the nearest hour.) |
**Procedure code must be billed on a paper CMS-1500 claim form with the supporting documentation listed in section 213.100.
016.06.06 Ark. Code R. § 076