Is A0428 covered by Medicare?

Coverage varies by code, payer, and clinical context. Cross-check the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC), and any commercial payer policy for non-Medicare patients. Many HCPCS Level II codes (especially DME and certain drugs) require prior authorization.

What documentation is required for A0428?

Documentation must support medical necessity per the payer LCD or commercial-payer policy. For DME codes: written order, face-to-face encounter where required, beneficiary education. For drug codes: NDC, dose administered, units, route, site, wastage if applicable. For ambulance: origin, destination, miles, medical necessity. For supplies: linked diagnosis and medical necessity.

What are common denial reasons for A0428?

The most common denial categories are CO-16 (information missing or incorrect), CO-50 (medical necessity), and CO-151 (benefit maximum reached, often for DME rental cycles). Specific denial behavior varies by payer and plan.

Who can I get help from on A0428 billing?

For specialty-specific coding questions, AAPC- and AHIMA-credentialed coders on the Medonix team handle production billing for U.S. healthcare practices including HCPCS Level II claims (drugs, DME, ambulance, Medicare-specific procedures). Book a discovery call at /audit/ to talk through your specialty and payer mix.

HCPCS Level II · Transportation, supplies, miscellaneous

A0428: Ambulance service, basic life support, non-emergency transport, (bls)

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A0428 is the HCPCS Level II code for Ambulance service, basic life support, non-emergency transport, (bls). Section A, Transportation, supplies, miscellaneous. Code-specific billing context provided.

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A0428Bls

Section: ACategory: Transportation, supplies, miscellaneousBillable

About this code

Bls.

A0428 is a HCPCS Level II code in section A (Transportation, supplies, miscellaneous). The full official descriptor is: Ambulance service, basic life support, non-emergency transport, (bls).

Ambulance service, basic life support, non-emergency transport. Document medical necessity for the non-emergency transport (bed-confined, requires medical attention en route). Pair with A0425 for mileage.

Payer-specific coverage rules vary. Always cross-check against the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC) or the commercial-payer policy.

Billing context

What practitioners watch for on A0428.

Code-specific billing guidance for A0428, written from production billing experience.

Documentation

Common denial categories

CO-16: Information missing or incorrect on the claim or supporting documentation. Add documentation specificity (NDC for drugs, serial number for DME, mileage for transport) and resubmit.
CO-50: Service not deemed medically necessary. Confirm the diagnosis-procedure relationship matches the payer LCD/NCD; attach clinical justification and resubmit.
CO-151: Payer benefit maximum reached for this period (often DME rental cycles). Verify benefit history; for DME rental-to-purchase cycles confirm month count and switch billing to purchase code where applicable.

Coverage signal

Non-emergency ambulance transports often require prior authorization. Medicare requires Certificate of Medical Necessity (CMN) and Physician Certification Statement (PCS) for repeat scheduled transports.

Common specialties

Emergency Medicine

Companion codes

Codes commonly billed alongside A0428 based on Medonix client production data and CMS coding guidance.

2 codes

A0425Ground mileage, per statute mileHCPCS
A0428Ambulance service, basic life support, non-emergencyHCPCS

CPT is a registered trademark of the American Medical Association. Codes shown for educational reference only.

Related codes

Other codes in section A.

Search all codes

Sources

Where this entry comes from.

NLM Clinical Tables Search Service: the official U.S. National Library of Medicine API for HCPCS Level II lookup.
CMS HCPCS Quarterly Update: the authoritative HCPCS Level II release with annual major updates each January.
CMS Medicare Coverage Database: Local Coverage Determinations and National Coverage Determinations for payer-specific rules.

Frequently asked

About HCPCS code A0428.

A0428 is the HCPCS Level II code for Ambulance service, basic life support, non-emergency transport, (bls). It belongs to section A (Transportation, supplies, miscellaneous). Document the supply, drug, or service per the code descriptor and pair with the diagnosis (ICD-10) supporting medical necessity.

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