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Railroad Medicare
Air Ambulance: Death of Beneficiary

In situations where the beneficiary dies, whether any payment under the Medicare ambulance benefit may be made depends on the time at which the beneficiary is pronounced dead by an individual authorized by the state to make such announcements. In each example below, air ambulance transport must have been otherwise medically necessary.

  1. If the time of death pronouncement is made prior to takeoff to point-of-pickup with notice to dispatcher and time to abort the flight, then no payment will be made
    • This scenario includes situations in which the air ambulance has taxied to the runway, and/or has been cleared for takeoff, but has not actually taken off
  2. If the time of death pronouncement is made after takeoff to point-of-pickup, but before the beneficiary is loaded, then the appropriate air base rate with no mileage or rural adjustment will be paid
    • Submit HCPCS modifier QL
  3. If the time of death pronouncement is made after the beneficiary is loaded onboard, but prior to or upon arrival at the receiving facility, then the service will be paid as if the beneficiary had not died
  4. If the air ambulance transport flight is aborted due to bad weather or other circumstances beyond the pilot's control and the transport would have been otherwise medically necessary, the following guidelines will apply:
    • If the flight is aborted any time before the beneficiary is loaded onboard (e.g., prior to or after take-off to point-of-pickup,) then no payment is made
    • If the transport flight is aborted after the beneficiary is loaded onboard, then the appropriate air base, mileage and rural adjustments will be allowed

Reference:


 

last updated on 10/02/2012
ver 1.0.51