Use KX modifier for ground ambulance services over 25 miles

Blue Cross Blue Shield of Michigan pays an approved amount for ambulance services to transport a patient up to 25 miles by ground. If required, we'll pay for a greater distance if the nearest medical facility capable of treating the patient's condition exceeds 25 miles. In either case, a claim must meet the following conditions:

• The service is medically necessary because transport by any other means would endanger the patient’s health.
• The service must transport the patient to a hospital or transfer the patient from a hospital to another treatment location, such as another hospital, skilled nursing facility, medical clinic or the patient's home.

For dates of service starting on Sept. 1, 2016, for any ground mileage over 25 miles, providers need to:

• Include the KX modifier on the claim.
• Place the modifier on the mileage line of the claim.
• Maintain supporting documentation for the transportation.

Providers will only be required to submit documentation of ambulance service if we request it for a review.