Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: November 29, 2019

These AFS Public Use Files (PUFs) are for informational purposes only. All official fee schedule files that are used to process Medicare claims are maintained by the Medicare Administrative Contractors (MACs) and could vary slightly from the amounts referenced in these files.  

Expand a menu to view information about the Ambulance Fee Schedule PUFs:

CY 2004 – CY 2025

See the Downloads section below for the AFS public use files for calendar years 2018-2025. For the AFS public use files for calendar years 2004-2017, view archive and legacy files. Note: Since calendar year 2017, we no longer create and publish, as in previous years, an AFS PUF package containing, along with the fee schedule, an index, background information, and the raw data file. Instead, we’ll provide and post to this website a sample data file in Excel “.xls” file format. You can download and use the file to calculate the appropriate Medicare Part B payment rates for Medicare covered ground and air ambulance transportation services.

CY 2025

The Consolidated Appropriations Act of 2023 includes a provision pertaining to the extension of the temporary ground ambulance transport add-on payments that were set to expire on December 31, 2022.

Temporary Ground Ambulance Transport Add-on Payments:

Division FF, section 4103 of the Consolidated Appropriations Act, 2023 extended payment provisions of previous legislation including the Bipartisan Budget Act (BBA) of 2018, the Medicare and CHIP Reauthorization Act (MACRA) of 2015, Protecting Access to Medicare Act of 2014, the Pathway for SGR Reform Act of 2013, the American Taxpayer Relief Act of 2012, the Middle Class Tax Relief and Job Creation Act of 2012, the Temporary Payroll Tax Cut Continuation Act of 2011, the Medicare and Medicaid Extenders Act of 2010, the Patient Protections and Affordable Care Act of 2010 (ACA), and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

Division FF, section 4103 of the Consolidated Appropriations Act, 2023 includes an extension of the temporary add-on payment under section 1834 (l)(12)(A) of the Act that were set to expire on December 31, 2022. They are extended through December 31, 2024. Without legislation,  this add-on payment will expire on December 31, 2024. The temporary add-on payment includes a 22.6% increase in the base rate for ground ambulance transports that originate in an area that’s within the lowest 25th percentile of all rural areas arrayed by population density (known as the “super rural” bonus). The CY 2025 Ambulance PUF does not include this add-on payment.

Division FF, section 4103 of the Consolidated Appropriations Act, 2023 includes an extension of the temporary add-on payments under section 1834 (l)(13)(A) of the Social Security Act (the Act) that were set to expire on December 31, 2022. They are extended through December 31, 2024.  Without legislation, these add-on payments will  expire on December 31, 2024. The temporary add-on payments include: 3% increase in the base and mileage rate for ground ambulance services that originate in rural areas (as defined by the ZIP code of the point of pickup) and a 2% increase in the base and mileage rate for ground ambulance services that originate in urban areas (as defined by the ZIP code of the point of pickup). The CY 2025 Ambulance PUF does not include this add-on payment.

The temporary add-on provisions described above will expire on December 31, 2024 and therefore, are not included in the calculation for the CY 2025 AFS PUF.

Data Elements of the AFS Data File

1. Contractor: This is the identifier used by the CMS to identify the entity which has the responsibility for adjudicating and paying claims within a defined geographical location.
   Part A MACs pay for ambulance services based on the ZIP code within the appropriate carrier geographic location.
2. Locality: This field represents subsets of locations within a defined jurisdiction with different geographic practice cost indices (GPCIs).
3. HCPCS: This field lists the associated HCPCS codes that are reported for services payable under the AFS.
4. Relative Value Units (RVU): RVUs set a numeric value for ambulance services relative to the value of a base level ambulance service. Since there are marked differences in resources necessary to furnish the various levels of ground ambulance services, different levels of payment are appropriate for the various levels of service. The different payment amounts are based on level of service. An RVU expresses the constant multiplier for a particular type of service (including, where appropriate, an emergency response). An RVU of 1.00 is assigned to the Basic Life Support (BLS) level of ground service, i.e., BLS has an RVU of 1; higher RVU values are assigned to the other types of ground ambulance services, which require a higher level of service than BLS.

RVUs

Service Level (HCPCS Code)	RVU
Basic Life Support, Non-emergency (BLS) (A0428)	1.00
Basic Life Support, emergency (BLS- Emergency) (A0429)	1.60
Advanced Life Support, non-emergency, Level 1 (ALS1) (A0426)	1.20
Advanced Life Support, emergency, Level 1 (ALS1- Emergency) (A0427)	1.90
Advanced Life Support, Level 2 (ALS2) (A0433)	2.75
Specialty Care Transport (SCT) (A0434)	3.25
Paramedic Intercept (PI) (A0432)	1.75

Air ambulance services (fixed wing and rotary) and ground and air mileage have no RVUs. However, on the fee schedule and this public use file, the base rate for air ambulance services and ground and air mileage is displayed as an RVU.

5. Geographic Practice Cost Index (GPCI): The non-facility practice expense (PE) portion of the GCPI of the Medicare physician fee schedule (PFS) is used to adjust payment to account for regional differences. The geographic areas applicable to the AFS are the same as those used for the PFS.
   
   The location where the beneficiary was put into the ambulance (“point of pickup”) establishes which GPCI applies. For multiple vehicle transports, i.e., where ground ambulance transports to an air ambulance, each leg of the transport is separately evaluated for the applicable GPCI.
   
   Thus, for the second (or any subsequent) leg of a transport, the point of pickup establishes the applicable GPCI for that portion of the ambulance transport. The GPCI is not applied to the mileage payment.
6. Base Rate: The Base Rate is a nationally uniform dollar amount used to calculate each HCPCS code payment amount, updated annually by the ambulance inflation factor (AIF).
7. (a) - Urban Base Rate/Urban Mileage
   1. Urban ground adjusted base rates – (RVU*(.3+ (.7*GPCI)))*BASE RATE* 1.00
   2. Urban air adjusted base rates – ((BASE RATE*.5)+(BASE RATE*.5*GPCI))*RVU
   3. Urban ground mileage rates – BASE RATE*1.00
   4. Urban air mileage rates – BASE RATE*1.00

This field displays 1 of 4 rates calculated as such for 2025:

See the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100) (PDF) for more information on how we calculate the urban base rate and mileage rate amounts.

7. (b) - Rural Base Rate/Rural Mileage

This field displays 1 of 4 rates calculated as such for 2025:

1. Rural ground adjusted base rates – (RVU*(.3+ (.7*GPCI)))*BASE RATE* 1.00
2. Rural air adjusted base rates – ((BASE RATE*.5)+(BASE RATE*.5*GPCI))*RVU*1.5
3. Rural ground mileage rates – BASE RATE*1.00
4. Rural air mileage rates – BASE RATE*1.50

The amount payable for the air base rate and air mileage rate in a rural area is 1.5 times the urban air base and mileage rate.

See the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100) (PDF) for more information on how we calculate the rural base rate and mileage rate amounts.

7. (c) - Rural Base Rate/Lowest Quartile
   
   The “super-rural bonus” payment rate applies only to ground ambulance transports originating in a rural area determined by the Secretary to be in the lowest 25th percentile of all rural populations arrayed by population density. The MACs will apply this amount to the base rate when the point of pickup (POP) is in one of a group of designated rural ZIP codes. To calculate the “super-rural bonus” payment rate of 22.6%, multiply any rural ground ambulance transport service payment rate by .226.   This add-on payment is not included in the calculation for the CY 2025 AFS PUF.    
8. Rural Ground Miles 1-17
   
   This field displays the amounts for rural ground miles 1-17.
   
   For ground rural miles 1-17, the mileage rate for ground transports provided in a rural area is 1.5 times the rural mileage rate per mile.
   
   The urban ground mileage rate applies to all miles of an ambulance transport originating in an urban area.
   
   This field displays a rural amount for the air base rate and air mileage. The amount payable for the base rate and all air miles for all air transportation originating in a rural area is 1.5 times the urban air base and mileage rates.

See 42 CFR § 414.610(c)(5)(i) for more information.

Note: For additional information regarding Medicare payment for Medicare covered ambulance transportation services, please contact your local MAC.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.