Ambulance Service Modifiers

For ambulance services, one-digit modifiers are combined to form a two-digit modifier that identifies the ambulance’s place of origin with the first digit, and the ambulance’s destination with the second digit.
One digit ambulance modifiers:

The QM and QN modifiers are valid for Medicare; however, the services would be denied under Part B Medicare as a Part A Medicare expense.


Ambulance Origin/Destination Modifiers


Modifier Modifier Description

D Diagnostic or therapeutic site other than ‘P’ or ‘H’ when these codes are used as origin codes. This modifier is to be used for transports to or from an Ambulatory surgical center (ASC) or a free-standing psychiatric facility.

E Residential, domiciliary, custodial facility (other than an 1819 facility)

G Hospital-based dialysis facility (hospital or hospital-related)

GM Multiple patients on one ambulance trip. Note: Providers need to submit the appropriate origin and destination modifiers in the first modifier position and HCPCS modifier GM in the second modifier position.

H Hospital. This modifier must be submitted for a psychiatric facility located at a hospital.

I Site of transfer (e.g., airport or helicopter pad) between types of ambulance vehicles

J Non hospital-based dialysis facility

N Skilled nursing facility (SNF) (1819 Facility)

P Physician’s office (includes HMO non-hospital facility, clinic, etc.) For Medicare purposes, urgent care centers, clinics and freestanding emergency rooms are considered physician offices.

QL Patient pronounced dead after ambulance called

R Residence

S Scene of accident or acute event

X (Destination code only) Intermediate stop at physician’s office on the way to the Hospital (includes HMO non-hospital facility, clinic, etc.)