What Does Medicare Cover?

Emergency Ambulance Transportation
In general, Medicare will cover medically necessary ambulance transportation to the nearest appropriate medical facility. Emergency ambulance transportation may qualify for Medicare coverage if the transport is a result of a sudden onset of a medical condition or traumatic injury manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, impairment to bodily function, or serious dysfunction to any bodily organ or part. Medicare requires that ambulance transportation be medically necessary and reasonable.

To be medically necessary, Medicare requires that the use of any other method of transportation would be hazardous to the patient’s health, whether or not any other methods of transportation are available. To be reasonable, for example, Medicare requires the patient to be transported to the nearest appropriate facility for treatment. Medicare will not pay for ambulance services when an ambulance was used for convenience of the patient, family, SNF staff or doctor, or because other means of transportation were not available at the time. The patient’s condition at the time of transport is the determining factor for a covered trip by Medicare/Medicaid.

Non-Emergency Ambulance Transportation
Certain medically necessary non-emergency ambulance transports are covered by Medicare, but wheelchair and gurney services are not covered benefits under the Medicare program.

Most non-emergency ambulance transports may require a certification of the medical necessity signed by the physician. Medicare will not pay for ambulance transportation to a particular hospital or facility that is not the nearest appropriate facility, or for the convenience of the patient, the family or physician. In general, Medicare will not pay for non-emergency ambulance service unless the patient is unable to get out of bed without assistance, and unable to walk, and unable to sit in a chair or wheelchair, and/or that transportation by any other means would pose a hazard to the patient’s health. These transports are generally scheduled ahead of time.

If you call 9-1-1 and we respond, but the patient appears not to meet medical necessity, or chooses not to be transported to the closest hospital facility, a patient may be asked to sign an “ABN” (Advance Beneficiary Notice) form before transporting. If the patients signs the ABN form making a choice and acknowledging they possibly do not meet Medicare requirements for transport by ambulance, and accepts responsibility for the entire bill, or any portion of the bill not paid for by Medicare we can transport to any hospital. Medicare patients may be billed for scene care if they refuse transport: $175.00 plus any supplies used