Medicare covers air ambulance transport only to the nearest hospital with appropriate facilities for treatment. Air ambulance services are not covered for transport to a facility that is not an acute care hospital, such as a nursing facility, physician’s office or a beneficiary's home.
Air ambulance transport is covered for transfer of a patient from one acute care hospital to another if transportation by land ambulance would endanger the beneficiary's health and the transferring hospital does not have adequate facilities to provide the medical services needed by the patient.
- Examples of such services include burn units, cardiac care units and trauma units
- A patient transported from one hospital to another is covered only if the receiving hospital is the nearest one with appropriate facilities
- An appropriate facility is an acute care hospital that is generally equipped to provide the needed hospital or skilled nursing care for the illness or injury involved
- The determination that a facility is 'appropriate' is based on the capability of the institution, equipment and personnel to provide services necessary to support the required medical care
- A physician or physician specialist must be available in the hospital to provide the necessary care required to treat the patient's condition at the time of transport
- The fact that a more distant hospital is better equipped does not mean that a closer hospital does not have the appropriate facilities. Such a finding is warranted only if the beneficiary's condition requires a higher level of trauma care or other specialized service available only at the more distant hospital.
- Air ambulance suppliers must continue to submit claims to the carrier that has jurisdiction for the locality in which the air ambulance is based (i.e., garaged or hangared)
- Transportation of a patient from one hospital to another is covered only if the receiving hospital is the nearest one with appropriate facilities
- An institution is not considered an appropriate facility if there is no bed, appropriate physician or specialized treatment unit immediately available
- Transportation from a hospital capable of treating the patient because the patient and/or his/her family prefer another specific hospital or physician is not covered
- Return transportation will rarely meet medical necessity and appropriate facility requirements
- When the necessary services can be provided at the place of origin, ambulance transfer to another location is not considered reasonable
- Round trips to other institutions to obtain specialized care services are not covered when that care could have been obtained at the originating institution
- The fact that a particular physician does or does not have staff privileges in a hospital is not a consideration in determining whether the hospital has appropriate facilities
- A distant institution better equipped (qualitatively or quantitatively) to care for the patient does not warrant a finding that a closer institution does not have appropriate facilities
- If the air transport was medically appropriate but the beneficiary could have been treated at a hospital closer than the one to which he/she was transported, the air transport payment is limited to the rate for the distance from the point of pickup to the nearer hospital
- If a determination is made that transport by air ambulance was necessary but land ambulance service would have sufficed, payment for air ambulance service is based on the amount payable for land transport, if less costly
- No payment will be made for the transport of ambulance staff or other personnel when the beneficiary is not onboard the ambulance