(Medicare Benefit Policy Manual)

Paramedic intercept services furnished on or after March 1, 1999, are payable separate from the ambulance transport when all of the requirements in the following three conditions are met:   I.  The intercept service(s) is:    Furnished in a rural area (as defined below) ;   Furnished under a contract with one or more volunteer ambulance services; and,   Medically necessary based on the condition of the beneficiary r eceiving the ambulance service.   II. The volunteer ambulance service involved must:    Meet Medicares certification requirements for furnishing ambulance services;    Furnish services only at the BLS level at the time of the intercept; and,    Be prohibited by state law from billing anyone for any service.   III. The entity furnishing the ALS paramedic intercept service must:    Meet Medicares certification requirements for furnishing ALS services, and,    Bill all recipients who receive ALS paramedic intercept serv ices from the entity, regardless of whether or not those recipients are Medicare beneficiaries.   For purposes of the paramedic intercept benefit, a rural area is an area that is designated as rural by a state law or regulation or that is located in a rural  census tract of a metropolitan statistical area (as determined under the most recent version of the Goldsmith Modification).  (The Goldsmith Modification is a methodology to identify small towns and rural areas within large metropolitan counties that are isolated from central areas by distance or other features).  The current list of these areas is periodically published in the Federal Register.   See Pub. 100- 04, Medicare Claims Processing Manual, Chapter 15 , "Ambulance," 20.1.4 for payment of paramedic intercept services.  Services in a Rural Area   Definition:  For purposes other than the paramedic intercept benefit (as defined above), services in a rural  area are services that are furnished (1) in an area outside a Metropolitan Statistical Area (MSA); or, (2) an area identified as rural using the most recent version of the  Goldsmith Modification even though the area is within an MSA.  Emergency Response  Definition:  Emergency response is a BLS or ALS1 level of service that has been provided in immediate response to a 911 call or the equivalent.  An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the  steps necessary to respond to the call.   The nature of an ambulances response (whether emergency or not) does not independently establish or support medical necessity for an ambulance transport.  Rather, Medicare coverage always depends on, among other t hings, whether the service(s) furnished is actually medically reasonable and necessary based on the patients condition at the time of transport.   Application:  The phrase 911 call or the equivalent is intended to establish the standard that the nature o f the call at the time of dispatch is the determining factor.  Regardless of the medium by which the call is made (e.g., a radio call could be appropriate) the call is of an emergent nature when, based on the information available to the dispatcher at the time of the call, it is reasonable for the dispatcher to issue an emergency dispatch in light of accepted, standard dispatch protocol.  An emergency call need not come through 911 even in areas where a 911 call system exists.  However, the determination to  respond emergently with a BLS or ALS ambulance must be in accord with the local 911 or equivalent service dispatch protocol.  If the call came in directly to the ambulance provider/supplier, then the providers/suppliers dispatch protocol and the dispatc hers actions must meet, at a minimum, the standards of the dispatch protocol of the local 911 or equivalent service.  In areas that do not have a local 911 or equivalent service, the protocol and the dispatchers actions must meet, at a minimum, the standards of the dispatch protocol in another similar jurisdiction within the state, or if there is no similar jurisdiction, then the standards of any other dispatch protocol within the state.  Where the dispatch was inconsistent with this standard of protocol, including where no protocol was used, the beneficiarys condition (for example, symptoms) at the scene determines the appropriate level of payment.   EMT -Intermediate  Definition:  EMT- Intermediate is an individual who is qualified, in accordance with stat e and local laws, as an EMT -Basic and who is also certified in accordance with state and local laws to perform essential advanced techniques and to administer a limited number of medications.  EMT -Paramedic  Definition: EMT- Paramedic possesses the qualifications of the EMT- Intermediate and, in accordance with state and local laws, has enhanced skills that include being able to administer additional interventions and medications.   Interfacility Transportation   Definition:   For purposes of SCT payment, an int erfacility transportation is one in which the origin and destination are one of the following:  a hospital or skilled nursing facility that participates in the Medicare program or a hospital -based facility that meets Medicares requirements for provider -based status.   30.1.2 - Air Ambulance Services  (Rev. 187, Issued: 05- 01-14; Effective: 08- 04-14; Implementation: 08 -04-14)  There are two categories of air ambulance services: fixed wing (airplane) and rotary wing (helicopter) aircraft. The higher operational costs of the two types of aircraft are recognized with two distinct payment amounts for air ambulance mileage.  The air ambulance mileage rate is calculated per actual loaded (patient onboard) miles flown and is expressed in statute miles (not nautical miles).   1.  Fixed Wing Air Ambulance (FW)   Fixed wing air ambulance is furnished when the beneficiarys medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate.  Generally, transport by fixed wing air  ambulance may be necessary because the beneficiarys condition requires rapid transport to a treatment facility, and either great distances or other obstacles, e.g., heavy traffic, preclude such rapid delivery to the nearest appropriate facility.  Transpo rt by fixed wing air ambulance may also be necessary because the beneficiary is inaccessible by a ground or water ambulance vehicle.   2.  Rotary Wing Air Ambulance (RW)   Rotary wing air ambulance is furnished when the beneficiarys medical condition is suc h that transport by ground ambulance, in whole or in part, is not appropriate.  Generally, transport by rotary wing air ambulance may be necessary because the beneficiarys condition requires rapid transport to a treatment facility, and either great distan ces or other obstacles, e.g., heavy traffic, preclude such rapid delivery to the nearest appropriate facility.  Transport by rotary wing air ambulance may also be necessary because the beneficiary is inaccessible by a ground or water ambulance vehicle.   Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R243BP  04/13/2018 Ambulance Transportation for a Skilled Nursing Facility (SNF) Resident in a Stay Not Covered by Part A - Medicare Benefit Policy Manual, Chapter 10 and Medicare Claims Processing Manual, Chapter 15  07/16/2018  10550 R236BP  06/17/2017 Medicare Benefit Policy Manual - Chapter 10, Ambulance Locality and Advanced Life Support (ALS) Assessment 09/18/2017  10110 R225BP  09/09/2016 Ambulance Staffing Requirements  12/12/2016  9761 R190BP  07/11/2014 Beneficiary Signature Requirements for Ambulance Services  08/12/2014  8760 R187BP  05/01/2014 Update to the Medicare Benefit Policy Manual to Restore Missing Air Ambulance Definitions  08/04/2014  8706 R133BP  10/22/2010 Air Ambulance Services  01/03/2011  7161 R130BP  07/29/2010 Definition of Ambulance Services 01/03/2011  7058 R125BP  05/14/2010 Ambulance Services -Joint Responses 06/15/2010  6949 R115BP  11/13/2009 Ambulance Services  01/04/2010  6707 R103BP  02/20/2009 Ambulance Services and Expiration of the Ambulance Fee Schedule Transition Period  03/20/2009  6318 R68BP  03/30/2007 Ambulance Fee Schedule  Ground Ambulance Services  Revision to the Specialty Care Transport (SCT) Definition  04/30/2007  5533 R14BP  05/28/2004 Ambulance Benefit Policy -Payment for Ambulance Services  07/01/2004  3225 R1BP  10/01/2003 Introduction to the Benefit Policy Manual N/A N/A Back to top of Chapter