Billing and Coding: Ambulance Services

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for **_Ambulance
Services L34549_**.

**Physician Certification & Order:**

The ambulance supplier is responsible for obtaining the signed written order
and certification with the appropriate signatures as expeditiously as
possible, and must obtain the signed order before billing for the service.

If the ambulance supplier is unable to obtain the written order and
certification with appropriate signatures within 21 calendar days following
the date of the service, the supplier may bill only if there is documentation
of good faith effort to obtain the order and certification.

When the transport involves a ground ambulance and an air ambulance, both
services may be reimbursed if both are medically necessary.

The ambulance provider or supplier must meet all coverage criteria in order
for payment to be made.

Medicare requires the signature of the beneficiary, or that of his or her
representative, for both the purpose of accepting assignment and submitting a
claim to Medicare.

Ambulance services that are not Medicare benefits because some other form of
transportation is not contraindicated, is an exclusion from Medicare benefits
under the statutory definition of that benefit at 1861(s)(7). An Advance
Beneficiary Notice of Noncoverage (ABN) is not needed and should not be used
in the following situations:

  1. Any denial where the patient could be transported safely by other means (these are denials under 1861(s)(7) of the Social Security Act (SSA)).
  2. Any denial that is based on not meeting an origin or destination requirement (these denials are inconsistent with 42 CFR 410.40 and generally also constitute 1861(s)(7) denials).
  3. A denial for mileage that is beyond the nearest appropriate facility (for the same reason as b. above).
  4. A denial where the physician certification statement or accepted alternative (e.g., certified mail) is not obtained (for the same reason as b. above).
  5. A convenience discharge, e.g., where the beneficiary is an inpatient at one hospital that can care for their needs, but wants to be transferred to a second hospital to be closer to family (for the same reason as b. above).

Not obtaining an ABN in these technical denial situations does not prevent the
supplier or provider from collecting denied charges from the beneficiary.

CMS developed the Beneficiary Notices Initiative web page to assist suppliers
and providers in informing beneficiaries that the services they are receiving
are excluded from Medicare benefits. Ambulance suppliers may develop their own
process to communicate to beneficiaries that they will be billed for excluded
services for which the ABN is not appropriate.

Multiple patient transports - a single payment allowance for mileage will be
prorated by the number of beneficiaries onboard.

Downcoding from air to ground is an 1862(a)(1)(A) denial.

Multiple arrivals - when multiple units respond to a call for services the
entity that provides the transport for the beneficiary should be the only
provider billing the service.