Guidelines for Billing Medicare for Ambulance Transportation

Medicare Coverage for Ambulance Transportation 

Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($233 in 2022). All ambulance companies that contract with Medicare must be participating providers. It’s really important to know the guidelines while billing Medicare for ambulance transportation. In this article, we shared basic ambulance transportation billing guidelines along with coverage rules which will help in receiving accurate reimbursement. Medicare Part B covers emergency ambulance services if:

  • An ambulance is medically necessary, meaning it is the ‘only safe way’ to transport
  • The reason for the trip is to receive a Medicare-covered service or to return from receiving care
  • Patient is transported to and from certain locations, following Medicare’s coverage guidelines, and
  • The transportation supplier meets Medicare ambulance requirements

To be eligible for coverage of non-emergency ambulance services, the patient must:

  • Be confined to their bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair) or, 
  • Need vital medical services during your trip that is only available in an ambulance, such as administration of medications or monitoring of vital functions

Medicare might cover unscheduled or irregular non-emergency trips, but if the patient lives in a skilled nursing facility (SNF), a doctor’s written order may be required within 48 hours after the transport. Medicare may also cover scheduled, regular trips if the ambulance supplier receives a written order from a physician ahead of time stating that transport is medically necessary.

Guidelines for Billing Medicare for Ambulance Transportation

  • The payment for medically necessary ambulance service is based on the level of service provided, not on the vehicle used. 
  • The cost of oxygen and its administration in connection with and as part of the ambulance service is covered. Under the ambulance FS, oxygen and other items and services provided as part of the transport are included in the FS base payment rate and are not separately payable.
  • The A/B MAC (A) is responsible for the processing of claims for ambulance services furnished by a hospital-based ambulance or for ambulance services provided by a supplier if provided under arrangements for an inpatient. The A/B MAC (B) is responsible for processing claims from suppliers; i.e., those entities that are not owned and operated by a provider. 
  • Ambulance supplier services furnished under arrangements with a provider, e.g., hospital or SNF are typically not billed by the supplier to its A/B MAC (B) but are billed by the provider to its A/B MAC (A). 
  • The items and services which include but are not limited to oxygen, drugs, extra attendants, supplies, EKG, and night differential are no longer paid separately for ambulance services. 
  • If ambulance claims are submitted with a code(s) that is/are not separately billable the payment for the code(s) is included in the base rate.

Patient Transportation

As mentioned earlier, ambulance services are separately reimbursable only under Part B. Once a beneficiary is admitted to a hospital, CAH, or SNF, it may be necessary to transport the beneficiary to another hospital or other site temporarily for specialized care while the beneficiary maintains inpatient status with the original provider. This movement of the patient is considered ‘patient transportation’ and is covered as an inpatient hospital or CAH service and as an SNF service when the SNF is furnishing it as a covered SNF service and payment is made under Part A for that service. 

If the beneficiary is a resident of an SNF and must be transported by ambulance to receive dialysis or certain other high-end outpatient hospital services, the ambulance transport may be separately payable under Part B. Also, if the beneficiary is an SNF resident and not in a Part A covered stay and must be transported by ambulance to the nearest supplier of medically necessary services not available at the SNF, the ambulance transport, including the return trip, may be covered under Part B.

Because the service is covered and payable as a beneficiary transportation service under Part A, the service cannot be classified and paid for as an ambulance service under Part B. This includes intra-campus transfers between different departments of the same hospital, even where the departments are located in separate buildings. Such intra-campus transfers are not separately payable under the Part B ambulance benefit. Such costs are accounted for in the same manner as the costs of such a transfer within a single building.

You can refer Medicare Interactive page on ‘Ambulance Transportation Basics’ for a detailed understanding of billing Medicare for ambulance transportation. MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle services. If you are looking for any assistance in ambulance billing, we can help. Our expert billers and coders are well-versed in ambulance transportation guidelines which ensures timely and accurate insurance reimbursements. To know more about our ambulance transportation billing services, contact us at info@medicalbillersandcoders.com / 888-357-3226