HCPCS Modifier QL

Published 07/16/2020

Description
Patient pronounced dead after ambulance called.

Guidelines and Instructions
  • Submit this modifier for ambulance transports for deceased patients that were pronounced dead after the ambulance is called
Background
  • In general, if the beneficiary dies before being transported, then no Medicare payment may be made. Medicare payment depends on the time at which the beneficiary was pronounced dead by an individual authorized by the state to make such pronouncements. For ambulance transports that meet the definition of medically necessary.

The charts below show the Medicare payment determination for various ground and air ambulance scenarios in which the beneficiary dies. In each case, the assumption is that the ambulance transport would have otherwise been medically necessary.

Ground Ambulance Scenarios: Beneficiary Death 

Time of Death PronouncementMedicare Payment Determination
Before dispatch. None.
After dispatch, before beneficiary is loaded onboard ambulance (before or after arrival at the point-of-pickup). The BLS base rate, no mileage or rural adjustment. Submit HCPCS modifier QL in these situations.
After pickup, prior to or upon arrival at the receiving facility. Medically necessary level of service furnished.

Air Ambulance Scenarios: Beneficiary Death

Time of Death PronouncementMedicare Payment Determination
Prior to takeoff to point-of-pickup with notice to dispatcher and time to abort flight. None.

Note: This scenario includes situations in which the air ambulance has taxied to the runway and/or has been cleared for takeoff, but has not taken off.
After takeoff to point-of-pickup but before the beneficiary is loaded. Appropriate air base rate with no mileage or rural adjustment. Submit HCPCS modifier QL in these situations.
After the beneficiary is loaded onboard, but prior to or upon arrival at the receiving facility. As if the beneficiary had not died.
If the flight is aborted for other reasons, such as bad weather, the Medicare payment determination is based on whether the beneficiary was onboard the air ambulance.

References