Tuesday, May 22, 2012

When Tricare cover ambulance services

TRICARE covers ambulance services in the following circumstances:


•     Emergency transport to a hospital

•     Transfer from one hospital to another hospital more capable of providing the required care as ordered by a physician

•     Transfers between a hospital or SNF and another facility for outpatient therapy or diagnostic services ordered by a physician

•     Transfers to and from a SNF when medically indicated

Note: Payment of ambulance transfers to and from a SNF may be included in the SNF prospective payment system (PPS).

Air or boat ambulance is only covered when the pickup point is inaccessible by a land vehicle, or when great distance or other obstacles are involved in transporting the patient to the nearest hospital with appropriate facilities, and the patient’s medical condition warrants speedy admission or is such
that transfer by other means is contraindicated. TRICARE does not cover ambulance services for these conditions:

•     Non-emergency ambulance services used instead of a taxi service or other normal transportation means when the patient’s condition would permit
use of regular transportation (Ambulance transportation is covered under the TRICARE Extended Care Health Option [ECHO] benefit when the beneficiary is being transported to and from institutions or facilities when the
beneficiary is receiving institutional care.)

•     Transport or tra nsfer of a patient primarily for the purpose of having the patient closer to home, family, friends, or a physician

•     Any type of medicabs or ambicabs that function as public passenger services transporting patients to and from medical appointments

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