Thursday, October 7, 2010


To be covered, ambulance services must be medically necessary and reasonable.
Medical necessity is established when the patient's condition is such that use of any other method of transportation is contraindicated. In any case in which some means of transportation other than an ambulance could be used without endangering the individual's health, whether or not such other transportation is actually available, no payment may be made for ambulance services.

So when submitting a claim to NHIC for payment, provide information on the claim that will substantiate the patient’s need to be transported by ambulance versus other forms of transportation.

In addition, the reason for the ambulance transport must be medically necessary. That is, the transport must be to obtain a Medicare covered service, or to return from such a service.

The Medicare ambulance benefit is a transportation benefit and without a transport there is no payable service.

The ambulance benefit is defined in title XVIII of the Social Security Act (the Act) in §1861(s)(7): “ambulance service where the use of other methods of transportation is contraindicated by the individual's condition, but only to the extent provided in regulations.”

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