Interfacility Transport Billing Guide

Interfacility transports move patients between hospitals, skilled nursing facilities, dialysis centers, and other care sites. They are usually scheduled or unscheduled non-emergency trips, which means closer medical necessity review, more PCS requirements, and a question emergency calls rarely raise: should this trip be billed to the patient’s insurance at all, or to the facility?

Who pays for the transport

• Hospital to hospital for admission or a higher level of care: Medicare generally covers the transport when the first hospital does not have the services the patient needs and the patient goes to the nearest appropriate facility. The claim goes to the patient’s insurance.
• Round trips during an inpatient stay: When a hospital inpatient is taken to another facility for a test or treatment and returned, the transport is generally part of the hospital’s inpatient payment. The ambulance provider bills the hospital under an arrangement, not Medicare.
• Skilled nursing facility residents in a covered Part A stay: Many of these transports are included in the facility’s consolidated billing and are billed to the SNF, with specific exceptions, such as transports tied to an inpatient hospital admission, emergency room visits, and certain dialysis and outpatient services.
• Discharges home or to a facility: Billed to the patient’s insurance when medical necessity is documented, usually as a non-emergency transport that needs a PCS.

Billing a bundled transport to Medicare leads to denials or recoupments, and billing a covered transport to a facility leaves revenue behind. A written agreement with each facility you serve, spelling out which transports it pays for, prevents most of these errors.

Level of service on interfacility trips

Interfacility transports are billed at BLS, ALS1, ALS2, or specialty care transport (SCT), based on the care the patient needed and received. SCT applies only when a critically ill or injured patient needs ongoing care beyond the paramedic scope, provided by health professionals in an appropriate specialty area, such as a critical care nurse managing infusions or a ventilator. Being a hospital-to-hospital transfer does not by itself make a trip SCT. See our ambulance billing codes guide for the full criteria.

Origin and destination modifiers for interfacility trips

• HH: hospital to hospital
• HN and NH: hospital to skilled nursing facility, and the reverse
• HR and HE: hospital to residence, or to a residential or custodial facility
• HD and DH: hospital to a diagnostic or therapeutic site, and back
• NG, NJ, RG, RJ: trips to hospital-based (G) or freestanding (J) dialysis facilities

Documentation and PCS requirements

Most interfacility trips are non-emergency, so Medicare expects a Physician Certification Statement: dated no earlier than 60 days before a scheduled, repetitive transport, or obtained within 48 hours after an unscheduled one. The run report still has to explain why the patient could not travel safely by other means, such as being bed-confined, needing monitoring or oxygen, or needing to be moved by stretcher. The sending facility’s records and the reason for the transfer should be referenced in the report.

Common interfacility billing mistakes

• Billing Medicare for transports that belong to the hospital or SNF payment
• Coding SCT for any hospital-to-hospital transfer without documented specialty-level care
• Missing or late PCS forms on non-emergency trips
• Narratives that say “transfer per facility request” without explaining medical necessity
• Wrong modifier letters for facility types, such as coding assisted living as a skilled nursing facility

For Medicare coverage rules in more depth, see our Medicare ambulance billing guide. Our ambulance billing services sort interfacility trips by payer responsibility before any claim is submitted.