NJ PIP Fee Schedule Exhibit 4: Ambulance Services
Exhibit 4 prices ambulance transport under New Jersey PIP. Its nine HCPCS codes cover ground and rotary wing air transport plus the two mileage codes that bill alongside them, each with a North and a South amount. The two mileage rates are the only ones identical in both regions.
Exhibit 4 in full, all 9 rows
How to read this table
- Code
- A HCPCS ambulance code. A0425 and A0436 are per statute mile; the rest are per transport.
- North, South
- The fee, chosen by the region where the service was rendered. 11:3-29.3(a) names Exhibit 4 explicitly among the schedules the regions govern.
| HCPCS | Description | North | South |
|---|---|---|---|
| A0425 | GROUND MILEAGE, PER STATUTE MILE | $8.93 | $8.93 |
| A0426 | AMBULANCE SERVICE, ALS, NON-EMERGENCY TRANSPORT, LEVEL 1 | $386.84 | $363.02 |
| A0427 | AMBULANCE SERVICE, ALS, EMERGENCY TRANSPORT, LEVEL 1 | $612.49 | $574.78 |
| A0428 | AMBULANCE SERVICE, BLS, NON-EMERGENCY TRANSPORT | $322.36 | $302.52 |
| A0429 | AMBULANCE SERVICE, BLS, EMERGENCY TRANSPORT | $515.78 | $484.02 |
| A0431 | AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING) | $4,790.49 | $4,571.17 |
| A0433 | ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2) | $886.50 | $831.92 |
| A0434 | SPECIALTY CARE TRANSPORT (SCT) | $1,047.68 | $983.17 |
| A0436 | ROTARY WING AIR MILEAGE, PER STATUTE MILE | $27.99 | $27.99 |
Source
- The schedule: N.J.A.C. 11:3-29 Appendix, Exhibit 4, published by the New Jersey Department of Banking and Insurance and effective for treatment rendered on or after January 4, 2013. It has not been amended since.
- Official files: the Department’s auto medical fee schedule page, the rule text and the Department’s own FAQ.
- This page: parsed from the Department’s Excel file, with every row count and every figure cross-checked against the Department’s PDF of the same exhibit. Free to download as one CSV of all seven exhibits, 7,553 rows, no sign-up.
What the rule says about this schedule
How is an ambulance run billed?
On two lines, not one. A transport carries a base code for the level of service and a separate mileage code for the distance, so a bill showing only a base rate is incomplete. Ground transports bill mileage under A0425 at $8.93 per statute mile; a rotary wing transport bills A0436 at $27.99 per mile.
Both mileage rates are the same in the North and the South, which is unusual on this schedule. Every base rate differs between the regions, by roughly six percent: basic life support emergency transport is $515.78 in the North and $484.02 in the South, advanced life support emergency transport $612.49 and $574.78.
Which ambulance codes are not on Exhibit 4?
Fixed wing air transport and its mileage code are absent. So is the volunteer ambulance code. The schedule prices rotary wing air transport at $4,790.49 in the North and $4,571.17 in the South, with no fixed wing equivalent published.
A code that is not on the schedule is not unreimbursable. 11:3-29.4(e) prices it as a reasonable amount considering the fee schedule amount for similar services in the region, and where the schedule holds nothing similar, at the usual, customary and reasonable fee. A fixed wing transport is priced that way rather than denied for absence.
How does this differ from the Medicare ambulance fee schedule?
They are different price lists with different geography. New Jersey PIP prices an ambulance run by two regions, North and South, set by ZIP code in 11:3-29.3. Medicare prices the same codes through a national base rate adjusted by payment locality, with statutory urban and rural add-ons decided by where the patient was picked up.
The two answer different questions and neither substitutes for the other. Our free Medicare ambulance fee schedule lookup prices the same HCPCS codes by state and locality for 2023 through 2026, which is the figure a bill reviewer needs when the payer is Medicare rather than a New Jersey PIP carrier.
Related lookups
For the same ambulance codes priced under Medicare rather than New Jersey PIP, use the free Medicare ambulance fee schedule lookup. For physician and professional codes under Medicare, use the Medicare rate lookup.