2018 Ambulance Fee Schedule: Revised
Effective: January 1, 2018
North Carolina
|
HCPCS Code
|
Contractor
|
Locality
|
RVU
|
GPCI(PE)
|
Base Rate
|
Urban Rate
|
Rural Rate
|
|---|---|---|---|---|---|---|---|
|
A0425
|
11502
|
00
|
1.00
|
0.931
|
$7.23
|
$7.37
|
$7.45
|
|
A0426
|
11502
|
00
|
1.20
|
0.931
|
$224.74
|
$261.80
|
$264.36
|
|
A0427
|
11502
|
00
|
1.90
|
0.931
|
$224.74
|
$414.51
|
$418.57
|
|
A0428
|
11502
|
00
|
1.00
|
0.931
|
$224.74
|
$218.16
|
$220.30
|
|
A0429
|
11502
|
00
|
1.60
|
0.931
|
$224.74
|
$349.06
|
$352.48
|
|
A0430
|
11502
|
00
|
1.00
|
0.931
|
$3,049.69
|
$2,944.48
|
$4,416.71
|
|
A0431
|
11502
|
00
|
1.00
|
0.931
|
$3,545.72
|
$3,423.39
|
$5,135.09
|
|
A0432
|
11502
|
00
|
1.75
|
0.931
|
$224.74
|
$381.78
|
$385.53
|
|
A0433
|
11502
|
00
|
2.75
|
0.931
|
$224.74
|
$599.95
|
$605.83
|
|
A0434
|
11502
|
00
|
3.25
|
0.931
|
$224.74
|
$709.03
|
$715.98
|
|
A0435
|
11502
|
00
|
1.00
|
0.931
|
$8.65
|
$8.65
|
$12.98
|
|
A0436
|
11502
|
00
|
1.00
|
0.931
|
$23.09
|
$23.09
|
$34.64
|
South Carolina
|
HCPCS Code
|
Contractor
|
Locality
|
RVU
|
GPCI(PE)
|
Base Rate
|
Urban Rate
|
Rural Rate
|
|---|---|---|---|---|---|---|---|
|
A0425
|
11202
|
01
|
1.00
|
0.912
|
$7.23
|
$7.37
|
$7.45
|
|
A0426
|
11202
|
01
|
1.20
|
0.912
|
$224.74
|
$258.14
|
$260.67
|
|
A0427
|
11202
|
01
|
1.90
|
0.912
|
$224.74
|
$408.72
|
$412.72
|
|
A0428
|
11202
|
01
|
1.00
|
0.912
|
$224.74
|
$215.11
|
$217.22
|
|
A0429
|
11202
|
01
|
1.60
|
0.912
|
$224.74
|
$344.18
|
$347.56
|
|
A0430
|
11202
|
01
|
1.00
|
0.912
|
$3,049.69
|
$2,915.50
|
$4,373.26
|
|
A0431
|
11202
|
01
|
1.00
|
0.912
|
$3,545.72
|
$3,389.71
|
$5,084.56
|
|
A0432
|
11202
|
01
|
1.75
|
0.912
|
$224.74
|
$376.45
|
$380.14
|
|
A0433
|
11202
|
01
|
2.75
|
0.912
|
$224.74
|
$591.56
|
$597.36
|
|
A0434
|
11202
|
01
|
3.25
|
0.912
|
$224.74
|
$699.12
|
$705.97
|
|
A0435
|
11202
|
01
|
1.00
|
0.912
|
$8.65
|
$8.65
|
$12.98
|
|
A0436
|
11202
|
01
|
1.00
|
0.912
|
$23.09
|
$23.09
|
$34.64
|
Virginia
|
HCPCS Code
|
Contractor
|
Locality
|
RVU
|
GPCI(PE)
|
Base Rate
|
Urban Rate
|
Rural Rate
|
|---|---|---|---|---|---|---|---|
|
A0425
|
11302
|
00
|
1.00
|
0.986
|
$7.23
|
$7.37
|
$7.45
|
|
A0426
|
11302
|
00
|
1.20
|
0.986
|
$224.74
|
$272.39
|
$275.06
|
|
A0427
|
11302
|
00
|
1.90
|
0.986
|
$224.74
|
$431.28
|
$435.51
|
|
A0428
|
11302
|
00
|
1.00
|
0.986
|
$224.74
|
$226.99
|
$229.21
|
|
A0429
|
11302
|
00
|
1.60
|
0.986
|
$224.74
|
$363.18
|
$366.74
|
|
A0430
|
11302
|
00
|
1.00
|
0.986
|
$3,049.69
|
$3,028.34
|
$4,542.51
|
|
A0431
|
11302
|
00
|
1.00
|
0.986
|
$3,545.72
|
$3,520.90
|
$5,281.35
|
|
A0432
|
11302
|
00
|
1.75
|
0.986
|
$224.74
|
$397.23
|
$401.12
|
|
A0433
|
11302
|
00
|
2.75
|
0.986
|
$224.74
|
$624.22
|
$630.34
|
|
A0434
|
11302
|
00
|
3.25
|
0.986
|
$224.74
|
$737.71
|
$744.94
|
|
A0435
|
11302
|
00
|
1.00
|
0.986
|
$8.65
|
$8.65
|
$12.98
|
|
A0436
|
11302
|
00
|
1.00
|
0.986
|
$23.09
|
$23.09
|
$34.64
|
West Virginia
|
HCPCS Code
|
Contractor
|
Locality
|
RVU
|
GPCI(PE)
|
Base Rate
|
Urban Rate
|
Rural Rate
|
|---|---|---|---|---|---|---|---|
|
A0425
|
11402
|
16
|
1.00
|
0.857
|
$7.23
|
$7.37
|
$7.45
|
|
A0426
|
11402
|
16
|
1.20
|
0.857
|
$224.74
|
$247.55
|
$249.97
|
|
A0427
|
11402
|
16
|
1.90
|
0.857
|
$224.74
|
$391.95
|
$395.79
|
|
A0428
|
11402
|
16
|
1.00
|
0.857
|
$224.74
|
$206.29
|
$208.31
|
|
A0429
|
11402
|
16
|
1.60
|
0.857
|
$224.74
|
$330.06
|
$333.30
|
|
A0430
|
11402
|
16
|
1.00
|
0.857
|
$3,049.69
|
$2,831.64
|
$4,247.46
|
|
A0431
|
11402
|
16
|
1.00
|
0.857
|
$3,545.72
|
$3,292.20
|
$4,938.30
|
|
A0432
|
11402
|
16
|
1.75
|
0.857
|
$224.74
|
$361.00
|
$364.54
|
|
A0433
|
11402
|
16
|
2.75
|
0.857
|
$224.74
|
$567.29
|
$572.85
|
|
A0434
|
11402
|
16
|
3.25
|
0.857
|
$224.74
|
$670.44
|
$677.01
|
|
A0435
|
11402
|
16
|
1.00
|
0.857
|
$8.65
|
$8.65
|
$12.98
|
|
A0436
|
11402
|
16
|
1.00
|
0.857
|
$23.09
|
$23.09
|
$34.64
|