Wednesday, July 20, 2016

Limitation of payment on Ambulance services

Limitations

** The medical condition of the beneficiary must necessitate ambulance transportation.

Emergency situations in which services are performed after the providers response to the onset of a medical condition manifested by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in one of the following:

o Place the beneficiary's health in serious jeopardy

o Seriously impair bodily functions; or

o Result in serious dysfunction of any bodily organ or part


** Trips that could have been scheduled are not considered emergencies.

Nonemergency transportation when the beneficiary's condition is such that a car or van cannot be used, e.g.:

o Beneficiary unconscious

o Beneficiary cannot sit up

o Oxygen or other life support required

o Extreme obesity or position of cast(s)

o Restraints required



Ambulance transportation for a deceased person is covered only if the person was pronounced dead while enroute to or upon arrival at destination. If the person was pronounced dead after the ambulance was called, but before pickup, the service to the point of pickup is covered. When an ambulance responds to a 911 call that is determined upon patient assessment to be nonemergent and the patient is transported, the ambulance provider must bill one of the nonemergency ambulance transportation procedure codes.
Emergency 911 calls that do not result in transporting the patient are not covered and may be billed to the patient.

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