Origin and Destination Modifier Table in ambulance billing

 Origin and Destination Modifier Table

The modifiers listed in the following Origin and Destination Modifier table are required for billing, as applicable. The first letter should indicate the transport’s place of origin, and the second letter should indicate the destination.

Origin and Destination Modifier Table

Modifier Description D Diagnostic or therapeutic site other than ‘P’ or ‘H’ E Residential, domiciliary, custodial facility (nursing home, not skilled nursing facility) G Hospital-based dialysis facility (hospital or hospital-related) H Hospital I Site of transfer (for example, airport or helicopter pad) between types of ambulance) J Non-hospital based dialysis facility N Skilled Nursing Facility P Physician’s office (includes HMO non-hospital based facility, clinic, etc.) R Residence S Scene of accident or acute event X Intermediate stop at physician’s office en route to the hospital. Note: Modifier X can only be used as a designation code in the second position of a modifier.
Note: Modifiers contained in this table are accepted and converted  by Tufts Health Plan to 00. The modifiers will reflect that no modifier was used to process the claim on the SOA and will populate the modifier field with 00.