Thursday, June 30, 2016

Ambulance Fee schedule


Payment Under the Ambulance Fee Schedule


Payment under the fee schedule for ambulance services:

• Includes a base rate payment plus a separate payment for mileage;

• Covers both the transport of the beneficiary to the nearest appropriate facility and all items and services associated with such transport; and

• Does not include a separate payment for items and services furnished under the ambulance benefit.
Payment for items and services is included in the fee schedule payment. Such items and services include but are not limited to oxygen, drugs, extra attendants, and EKG testing (e.g., ancillary services) - but only when such items and services are both medically necessary and covered by Medicare under the ambulance benefit.

For additional information on the fee schedule, contractors may refer to the “Ambulance Services Center” on the CMS Web site at http://www.cms.hhs.gov/center/ambulance.asp.

Jurisdiction


Claims jurisdiction for suppliers is considered to be where the ambulance vehicle is garaged or hangared. Claims jurisdiction for institutional based providers is based on the primary location of the institution.


Services Provided

Payment is based on the level of service provided, not on the vehicle used. Occasionally, local jurisdictions require the dispatch of an ambulance that is above the level of service that ends up being provided to the Medicare beneficiary. In this, as in most instances, Medicare pays only for the level of service provided, and then only when the service provided is medically necessary.

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