Land Ambulance: What Medicare Covers

Published 05/28/2020

Ambulance services may be considered for payment under Medicare Part B if the patient's transport is not payable under Part A. Medicare covers ambulance services only if they are furnished to a beneficiary whose medical condition is such that other means of transportation would be contraindicated. A patient whose condition permits transport in any type of vehicle other than an ambulance would not qualify for ambulance services under Medicare.

The patient's condition at the time of the transport is the determining factor in whether medical necessity is met or not. Palmetto GBA will presume the medical necessity requirement is met if submitted documentation indicates as follows:

  • The patient was transported in an emergency situation (e.g., as a result of an accident, injury or acute illness)
  • The patient needed to be restrained to prevent injury to the beneficiary or others
  • The patient was unconscious or in shock
  • The patient required oxygen or other emergency treatment during transport to the nearest appropriate facility
  • The patient exhibits signs and symptoms of acute respiratory distress or cardiac distress such as shortness of breath or chest pain
  • The patient exhibits signs and symptoms that indicate the possibility of acute stroke
  • The patient had to remain immobile because of a fracture that had not been set or the possibility of a fracture
  • The patient was experiencing severe hemorrhage
  • The patient was bed confined before and after the ambulance trip
  • The patient could be moved only by stretcher

These services may be provided on an emergency or non-emergency basis. In the absence of one of these situations listed previously, there must be clear documentation that establishes medical need where the evidence indicates the existence of the circumstances listed below (please note, this documentation is not required to be submitted with the claim):

  • The patient's condition would not ordinarily require movement by stretcher
  • The individual was not admitted as a hospital inpatient except in accident cases
  • The ambulance was used solely because other means of transportation were unavailable
  • The individual merely needed assistance in getting from his room or home to a vehicle

Palmetto GBA will not change a code submitted or add any modifier that may be required for payment when processing your claim.


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