Ambulance Services Provided Outside the United States

The term "United States" means the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands and American Samoa. For purposes of services furnished on a ship, it includes the territorial waters adjoining the land areas of the United States.

• For air transport outside of the U.S. ZIP Code to a drop off outside of the U.S. (in Canada or Mexico) the point of pickup ZIP Code is the closest U.S. ZIP Code to the point of pickup
• For air transport from areas outside of the U.S. to the U.S., the point of pickup ZIP Code is the ZIP Code at the U.S. border at the point of crossing

Medicare provides for limited coverage for medical services furnished outside the United States. In general, hospital or medical services are not covered outside the country, with a few exceptions. The Social Security Act (SSA) specifies the following exceptions to the "foreign" exclusion:

1. Inpatient hospital services for treatment of an emergency in a foreign hospital that is closer to, or more accessible from, the place the emergency arose than the nearest U.S. hospital that is adequately equipped and available to deal with the emergency, provided either of the following conditions exist:
   • emergency arose within the U.S.; or
   • emergency arose in Canada while the individual was traveling, by the most direct route and without unreasonable delay between Alaska and another state
2. Inpatient hospital services at a foreign hospital that is closer to, or more accessible from, the individual’s residence within the U.S. than the nearest U.S. hospital that is adequately equipped and available to treat the individual’s condition, whether or not an emergency exists
3. Physician and ambulance services in connection with, and during, a foreign inpatient hospital stay that is covered in accordance with either of the above
4. Services rendered on board a ship in a United States port, or within six hours of when the ship arrived at, or departed from, a United States port, are considered to have been furnished in United States territorial waters. Services not furnished in a United States port, or within six hours of when the ship arrived at, or departed from, a United States port, are considered to have been furnished outside United States territorial waters, even if the ship is of United States registry (see Medicare Claims Processing Manual Chapter 1, General, section 10.1.4.7 for a description of claims processing procedures).

References

• Beneficiary Notice 
• CMS Ambulance Services Center
• Medicare Benefit Policy Manual, Chapter 10, Ambulance (PDF) 
• Medicare Claims Processing Manual, Chapter 15, Ambulance (PDF)
• Code of Federal Regulations
  • §410.40 Coverage of Ambulance Services
  • §410.41 Requirements