Monday, June 20, 2016

Does Amublance billing covered under part A ?

Summary of the Benefit


Ambulance services are covered under Medicare Part B. However, a Part B payment for an ambulance service furnished to a Medicare beneficiary is available only if the following, fundamental conditions are met:

• Actual transportation of the beneficiary occurs.

• The beneficiary is transported to an appropriate destination.

• The transportation by ambulance must be medically necessary, i.e., the beneficiary’s medical condition is such that other forms of transportation are medically contraindicated.

• The ambulance provider/supplier meets all applicable vehicle, staffing, billing, and reporting requirements.

• The transportation is not part of a Part A service.


Other requirements specified in this chapter or in the above-cited CMS Manuals may also apply to the provider/supplier or to a particular transport or billing.


 Payment Rules


Medicare covered ambulance services are paid based on the Medicare ambulance fee schedule.

The following subsections describe how contractors calculate the payment amount. Section 20.1 and its subsections describe how the payment amount is calculated for the fee schedule. The other subsections in §20 provide information on certain components of the payment amount (e.g., mileage) or specialized payment amounts (e.g., air ambulance).

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