A0428: Non-emergency BLS ambulance code

What A0428 pays for

A0428 pays the base rate for one non-emergency ambulance trip at the basic life support level. The HCPCS descriptor reads “Ambulance service, basic life support, non-emergency transport, (BLS).” CMS added it on January 1, 2001, and Medicare covers it when the coverage rules are met. The base amount covers the ambulance, its staff, and routine supplies. Miles with the patient on board are billed on their own line, most often as A0425.

On Medicare’s scale, non-emergency BLS is the lowest-weighted ground level at 1.00 relative value units. For comparison, emergency BLS is 1.60, non-emergency ALS level 1 is 1.20, and specialty care transport is 3.25. One reduction applies only at the non-emergency BLS level. For dialysis runs that carry beneficiaries with end-stage renal disease, the A0428 base and its mileage have each been reduced by 23 percent since October 1, 2018.

The crew and vehicle behind the code

A0428 describes who and what made the trip, and federal rules define both:

• Crew. At least two people who meet state and local requirements. At least one must be certified as an EMT-Basic, or higher, and be authorized to run the lifesaving equipment on board.
• Vehicle. Built to respond to emergencies or give acute medical care, and compliant with the state and local laws for emergency vehicles. It must carry warning lights and sirens where the state requires them, a two-way radio or wireless phone, a stretcher, linens, emergency supplies, and oxygen.
• Billing. Origin and destination modifiers on every trip, and a statement on the claim that the required certification is on file.

Medical necessity and the certification statement

The patient’s condition is what earns the code. Medicare’s coverage rule, 42 CFR 410.40, pays for a non-emergency ambulance ride only if “other means of transportation are contraindicated.” The patient’s condition also has to call for BLS care, not just a ride. Being bed-confined helps make that case without settling it. Medicare’s three-part definition requires a patient who needs help getting out of bed, cannot walk, and cannot stay seated in any chair, wheelchair included.

The paperwork depends on how the trip is scheduled:

1. Scheduled and repetitive, for example a standing dialysis schedule: the physician’s signed certification must be in hand before the trip and carry a date within the prior 60 days.
2. Unscheduled or one-time, when the patient lives in a facility and is under a physician’s care: the physician’s certification can come after the ride, if the supplier obtains it no more than 48 hours later. A patient at home or in a facility who is not under a physician’s direct care needs no physician certification. When the physician’s statement cannot be obtained, a physician assistant, nurse practitioner, clinical nurse specialist, registered or practical nurse, social worker, case manager, or discharge planner can sign, provided they know the patient’s condition and work for the physician or the sending facility.
3. No signature after 21 calendar days: document the attempts, such as a signed postal return receipt, and then submit the claim.

Repeat schedules also run into Medicare’s RSNAT prior authorization model, which has reached every state since August 2022 and reviews A0426 and A0428. Suppliers may bypass it, but after the first three round trips those claims go to prepayment medical review.

Why a stretcher van trip is not A0428

The dividing line is care during the ride, not the stretcher. In Colorado’s manual, a stretcher van moves a member who must lie prone or supine and needs no medical attention en route, and it bills T2005 with T2049 for miles. An ambulance bills A0428 because it meets the crew, equipment, and licensing rules above. A stretcher van does not meet those ambulance vehicle and staffing rules, so a stretcher on board does not make its trip an A0428 trip.

The price gap is wide. Colorado pays $174.47 for an A0428 trip from July 1, 2026, against $49.42 for a stretcher van base. South Dakota pays $280.09 against $109.66. Billing a stretcher van trip as A0428 claims a service the vehicle cannot provide.

Medicaid programs add their own gates. Colorado covers a non-emergency ambulance ride once the member’s medical professional states that the member needs one to travel safely. Oregon wants every non-emergency ride authorized in advance, and it sends non-emergency ambulance requests to the local brokerage. For the full comparison of van and ambulance work, see NEMT vs ambulance and our guide to stretcher transportation.

Matching the trip to the vehicle

The simplest protection against a wrong base code is sending the right vehicle in the first place. On the HealthRide dispatch board, each trip carries the rider’s wheelchair, stretcher, or oxygen needs, and dispatch matches those needs to a van equipped for them.