Ambulance services are separately payable only under Part B. There are certain
circumstances in which the service is covered and payable as a beneficiary transportation service under Part A; however in this case the service cannot be classified and paid for as an ambulance service under Part B. Payment may be made for expenses incurred for ambulance service provided the conditions specified in the following subsections are met.
The Medicare ambulance benefit is a transportation benefit and without a transport there is no payable service. When multiple ground and/or air ambulance providers/suppliers respond, payment may be made only to the ambulance provider/supplier that actually furnishes the transport.
Vehicle and Crew Requirement
Any vehicle used as an ambulance must be designed and equipped to respond to medical emergencies and, in nonemergency situations, be capable of transporting beneficiaries with acute medical conditions. The vehicle must comply with State or local laws governing the licensing and certification of an emergency medical transportation vehicle. At a minimum, the ambulance must contain a stretcher, linens, emergency medical supplies, oxygen equipment, and other lifesaving emergency medical equipment and be equipped with emergency warning lights, sirens, and telecommunications equipment as required by State or local law. This should include, at a minimum, one 2-way voice radio or wireless telephone.
Vehicle Requirements for Basic Life Support and Advanced
Basic Life Support ambulances must be staffed by at least two people, at least one of
whom must be certified as an emergency medical technician (EMT) by the State or local
authority where the services are being furnished and be legally authorized to operate all
lifesaving and life-sustaining equipment on board the vehicle. Advanced Life Support
(ALS) vehicles must be staffed by at least two people, at least one of whom must be
certified by the State or local authority as an EMT-Intermediate or an EMT-Paramedic.
Verification of Compliance
In determining whether the vehicles and personnel of each supplier meet all of the above requirements, carriers may accept the supplier’s statement (absent information to the contrary) that its vehicles and personnel meet all of the requirements if:
1. The statement describes the first aid, safety, and other patient care items with
which the vehicles are equipped;
2. The statement shows the extent of first aid training acquired by the personnel
assigned to those vehicles;
3. The statement contains the supplier’s agreement to notify the carrier of any
change in operation which could affect the coverage of ambulance services; and
4. The information provided indicates that the requirements are met.
The statement must be accompanied by documentary evidence that the ambulance has the equipment required by State and local authorities. Documentary evidence could include a letter from such authorities, a copy of a license, permit, certificate, etc., issued by the authorities. The carrier will keep the statement and supporting documentation on file.
When a supplier does not submit such a statement or whenever there is a question about a supplier’s compliance with any of the above requirements for vehicle and crew (including suppliers who have completed the statement), carriers will take appropriate action including, where necessary, on-site inspection of the vehicles and verification of the qualifications of personnel to determine whether the ambulance service qualifies for reimbursement under Medicare. Since the requirements described above for coverage of ambulance services are applicable to the overall operation of the ambulance supplier’s service, information regarding personnel and vehicles need not be obtained on an individual trip basis.