MLN Matters® Number: MM6707
Related Change Request (CR) #: 6707
Related CR Release Date: November 13, 2009
Effective Date: January 1, 2010
Related CR Transmittal #: R115BP
Implementation Date: January 4, 2010
Provider Types Affected
Ambulance providers and suppliers submitting claims to Medicare contractors (carriers, Fiscal Intermediaries (FI) and Medicare Administrative Contractors (MAC)) for ambulance services provided to Medicare beneficiaries.
Provider Action Needed
This article, based on CR 6707, advises you that the Medicare Benefit Policy Manual Chapter 10 – Ambulance Service section 10.3 has been revised to incorporate consistent manual language to the definition of 'The Destination.' There is no change to policy. Please make sure your billing staffs are aware of this update.
Background
The Medicare Benefit Policy Manual Chapter 10 – Ambulance Service section 10.3 has been updated to incorporate consistent manual language. The change states that “an ambulance transport is covered to the nearest appropriate facility to obtain necessary diagnostic and/or therapeutic services (such as a CT scan or cobalt therapy) as well as the return transport. In addition to all other coverage requirements, this transport situation is covered only to the extent of the payment that would be made for bringing the service to the patient.” The word 'appropriate' has been added to that statement.
Additional Information
The official instruction, CR 6707, issued to your Medicare contractor regarding this change may be viewed at
If you have questions, please contact the Palmetto GBA Provider Contact Center at their toll-free number, (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2009 American Medical Association.