Medicare Part B covers ambulance transportation where:
1. A patient needs to get to a hospital or skilled nursing facility for medically necessary care; and
2. Any other type of transportation would endanger the health of the patient.
Medicare Part B will pay for non-emergency ambulance transport of a patient when the patient’s physician certifies in writing that any other of transportation would endanger the health of the patient. That is, the physician’s certification must expressly state that the non-emergency ambulance transport is medically necessary to ensure the health and safety of the patient.
In order for Medicare coverage to be guaranteed, it is imperative to obtain prior approval from Medicare Part B.
Medicare Part B covers a non-emergency air ambulance transport only if travel by long distance ground ambulance would present a serious danger to the patient’s health. The patient’s attending physician should make this certification in writing and prior approval from Medicare should be obtained.
Medicare Part C plans must cover everything covered under Medicare Part A and Part B. In some instances, Part C Medicare Advantage Plan may cover extended services or extended coverage. Contact the individual plan to ascertain if non-emergency patient transport is covered under the Part C plan and the requirements for coverage.
Generally, Medicare will pay for 80% of the Medicare pre-approved cost of the ambulance transport. Ambulance providers cannot charge more than the Medicare approved amount. Medicare only pays for transportation to the closest appropriate facility that can provide the medical care required. Where a patient chooses hospital or medical facility further away, Medicare’s payment will be based on the cost of transportation to the nearest appropriate hospital or medical facility.
• The care must be “medically necessary” for the patient and must be ordered or prescribed by a licensed physician or other authorized medical provider;
• Medicare (or a Medicare Part C plan) must agree that the care is necessary and proper.
• The care must be performed or delivered by an authorized Medicare healthcare provider (one who participates in Medicare).
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