ICD-10-CM POA Exempt Codes

Air and Ground Transportation Indicators

Value Description 

C1 Inter-facility transport (to a higher level of care) determined necessary by the originating facility based upon the Emergency Medical Treatment and Active Labor Act (EMTALA) regulations and guidelines. The patient’s condition should also be reported on the claim with a code selected from either the emergency or non-emergency category on the list. 

C2 Patient is being transported from one facility to another because a service or therapy required to treat the patient’s condition is not available at the originating facility. The patient’s condition should also be reported on the claim with a code selected from either the emergency or nonemergency category on the list. In addition, the information about what service the patient requires that was not available should be included in the narrative field of the claim. 

C3 Secondary code where a response was made to a major incident or mechanism of injury. All such responses are appropriately Advanced Level Service responses. A code that describes the patient’s condition found on scene should also be included on the claim, but use of this modifier is intended to indicate that the highest level of service available response was medically justified. 

C4 Indicates that an ambulance provided a medically necessary transport, but the number of miles on the claim form appears to be excessive. This should be used only if the facility is on divert status or a particular service is not available at the time of transport only. The provider or supplier must have documentation on file clearly showing why the beneficiary was not transported to the nearest facility and may include this information in the narrative field. 

C5 Indicates situations where a patient with an ALS-level condition is encountered, treated and transported by a BLS-level ambulance with no ALS level involvement whatsoever. This situation would occur when ALS resources are not available to respond to the patient encounter. 

C6 Indicates situations when an ALS-level ambulance would always be the appropriate resource chosen based upon medical dispatch protocols to respond to a request for service. Claims including this transportation indicator should contain two primary codes. The fi rst condition will indicate the BLS-level condition corresponding to the patient’s condition found on-scene and during the transport. The second condition will indicate the ALS-level condition corresponding to the information at the time of dispatch that indicated the need for an ALS-level response based upon medically appropriate dispatch protocols. 

C7 Indicates circumstances where IV medications were required en route. The patient’s condition should also be reported on the claim with a code selected from the list. 

Air Only 

All “transportation indicators” imply a clinical benefit to the time saved with transporting a patient by an air ambulance versus a ground or water ambulance. 

Value Description 

D1 Long Distance: patient’s condition requires rapid transportation over a long distance. 

D2 Under rare and exceptional circumstances, traffic patterns preclude ground transport at the time the response is required. 

D3 Time to get to the closest appropriate hospital due to the patient’s condition precludes transport by ground ambulance. Unstable patient with need to minimize out-of hospital time to maximize clinical benefits to the patient. 

D4 Pick up point not accessible by ground transportation.