Medicare Policy Concerning Bed-Confinement:
Bed-confinement, by itself, is neither sufficient nor is it necessary to determine the coverage for Medicare ambulance benefits. It is simply one element of the beneficiary's condition that may be taken into account when determining the medical necessity of an ambulance transport. The term 'bed confined' is not synonymous with 'bed rest' or 'non-ambulatory.' Bed confined is one factor to be considered but is not meant to be the sole criterion to determine medical necessity.
Bed confined requires all the following criteria to be met:
- The beneficiary is unable to get up from bed without assistance
- The beneficiary is unable to ambulate
- The beneficiary is unable to sit in a chair or wheelchair
A Medicare ambulance transport may only be payable if other forms of transportation is contraindicated by the beneficiary's condition.
Limitations:
Bed confinement is one factor to be considered but is not meant to be the sole criterion to determine medical necessity for ambulance transport.
- In any case in which some means of transportation other than an ambulance could be utilized without endangering the individual’s health, whether or not such other transportation is actually available, no payment will be made for ambulance services
- Ambulance service for beneficiaries with the diagnosis of chronic renal disease or end stage renal disease requiring dialysis is not routinely covered under the Medicare program. Ambulance suppliers are responsible for maintaining documentation of medical necessity for this coverage
- Ambulance transport is not medically necessary when the only reason is to provide supplemental oxygen to a beneficiary who is already receiving portable oxygen under the DME benefit
- Payment for items and services is included in the fee schedule payment. Such items and services include but are not limited to oxygen and drugs and only when such items are medically necessary and covered by Medicare under the ambulance benefit.
- Charges for extra attendants, waiting time, and EKGs are not separately reimbursable. Payment for these services is considered to be included in payment for the base rate.
- The use of ALS is medically appropriate only for life-threatening situations
- Neither the presence nor absence of the signed physician certification statement necessarily proves or disproves the medical necessity for the ambulance transport
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