Ambulance Services
Compare the median payments for ground and air ambulance transport services by county from January 1, 2017 – December 31, 2023.
The Steps MHDO Takes to Calculate Ambulance Service Payments on CompareMaine
Step 1: Filter the Data
To create the analytic set, we filter the data by removing claims with missing information, claims from public payors (Medicare and Medicaid), and commercial claims from Medicare Advantage or for anyone 65 years old or older(as these claims are often paid for in-part by a public payor like Medicare and including them would distort the average for commercial payors). We also remove claims from providers with a business practice location outside of Maine.
Step 2: Find Claims Linked to a Service or Procedure
We identify the claims associated with the following ambulance transport services:
- Ground Transport
- CPT Code A0428 – Ambulance service, basic life support, non-emergency transport
- CPT Code A0429 – Ambulance service, basic life support, emergency transport
- CPT Code A0426 – Ambulance service, advanced life support, non-emergency transport, level 1
- CPT Code A0427 – Ambulance service, advanced life support, emergency transport, level 1
- CPT Code A0433 – Advanced life support, level 2
- CPT Code A0434 – Specialty care transport
- CPT Code A0425 – Ground mileage, per statute mile
- Air Transport
- CPT Code A0430 – Ambulance service, conventional air services, fixed wing transport, one way
- CPT Code A0431 – Ambulance service, conventional air services, rotary wing transport, one way
- CPT Code A0435 – Fixed wing air mileage, per statute mile
- CPT Code A0436 – Rotary wing air mileage, per statute mile
To create ambulance transport episodes of care, we match mileage codes to the corresponding ambulance transport service codes, since multiple transport types (air or ground) can occur within the same episode of care. We match the ground mileage CPT Code A0425 to the ground transport types (CPT Codes A0426, A0427, A0428, A0429, A0433, A0434). We match the fixed wing air mileage CPT Code A0435 with the fixed wing transport CPT Code A0430; we match the rotary wing air milage CPT Code A0436 with the rotary wing transport type CPT Code A0431. Then, we calculate the total mileage for each ambulance transport episode of care.
Step 3: Calculate the Average Payment
We use the median to calculate the average payment and average mileage for each of the eleven ambulance transport services listed above by county. We also tally and display the number of ambulance transport providers in each county submitting claims for each service, and the number of times the specific CPT Code appeared in the claims data by payor and calendar year.
We do not calculate a payment estimate for any ambulance service with fewer than five claims for that service for a specific payor, calendar year, and county combination in the analytic set.