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Back  RFI # 1876: Ambulance Mileage

Formal vs. Informal Help Informal Formal

Submitter

Tony Benson

Description

The Professional guide (005010X222A1) specifies that ambulance transport mileage is to be sent at the 2300/2400 loops and in CR106.

However, these mileage claims are also being sent with mileage HCPCS codes in SV101 (Example: A0425 - Ground Mileage, Per Statute Mile). Therefore, the unit quantity in SV104 should be defined as mileage related to that transport.

We are seeing great disparity in the way ambulance transport claims are sending mileage. Would it be reasonable to assume that CR106 and SV104 are always the same? Both have the same Data Type of R and therefore would allow for fractional mileage.

Example of what is being received:

SV1*HC:A0425*300*UN*1***1~
CR1****A*DH*5.2~

Submitter Assigned Keywords

CR1 CR106 SV104 Ambulance Mileage

Response

For multiple transports on one claim, the CR1 segment is reported on each service line that has a HCPCS mileage procedure code. The mileage in CR106 is intended to be the same information as the mileage in the SV104 of that service line. The claim level CR106 would then contain the sum of all of the line level CR106 values.

For a claim with a single transport, the mileage in the claim level CR1 segment is intended to be the same information as the mileage in the SV104 for the service line that contains the HCPCS mileage procedure code.The service level CR1 segment is not sent.

Please see RFI #1858 for additional information on reporting precision.
Submission 10/31/2013
Status Date 4/4/2014
Status F - Final
Primary References
Document 005010X222A1
Section2.4
Segment IDCR1
Element Position06