Patient, Physician or Family Convenience Transports billing tips

Patient, Physician or Family Convenience Transports

Coverage is not available if transport is requested solely because the patient and/or family prefer a specific hospital or physician, or so the patient can be closer to home. A request from or on behalf of a Medicare beneficiary for transport by ambulance for the beneficiary's personal convenience or that of the doctor or beneficiary’s family is not a Medicare benefit under section 1861(s)(7) of the Social Security Act. If you furnish a service pursuant to such a request, then you may charge the individual your full fee and collect the fee at a time of your choosing. You should advise the beneficiary, in advance of furnishing the service, that such "convenience transportation" is not covered under Medicare. However, the use of an Advance Beneficiary Notice (ABN) is not indicated. You may use a “Notice of Exclusions from Medicare Benefits (NEMB)” to document the agreement for private payment of such services.

Patient Assistance
If the sole reason for ambulance transport was that the patient needed assistance into the home (e.g., patient resides on second floor), the services would not be considered for payment.

Patient Refuses Transport
In a situation where the patient refuses transport, Medicare does not cover the services. This also applies to any medical services provided. The beneficiary would be liable for the expenses. The Medicare ambulance benefit is a transportation benefit only.

Physician Office Transport
Coverage of transports to or from a physician’s office is allowed only in the following instance:
• The ambulance transport enroute to a Medicare covered destination, and
• When, during transport, the patient requires immediate professional attention and the ambulance stops at the physician’s office for stabilization and then, transports the patient to the hospital.

NOTE:
The SX PH modifiers for the origin and destination must be submitted to identify that the above circumstances existed.