Ambulance Transport: Death of Beneficiary


In situations where the beneficiary dies, 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 pronouncements.

  • No payment will be made when the time of death pronouncement for the beneficiary is before the ambulance is dispatched
  • When the time of death pronouncement for the beneficiary is after the ambulance is dispatched but before the beneficiary is loaded onboard the ambulance (before or after arrival at the point-of-pickup), Palmetto GBA will reimburse the ambulance fee schedule amount for the transportation (base rate) only
  • Payment will be made based on the level of service furnished when the pronouncement of death is made after the pickup, prior to or upon arrival at the receiving facility
  • Mileage and rural adjustments are not reimbursed in these situations. Submit HCPCS modifier QL (patient pronounced dead after ambulance called).

The following table includes scenarios for beneficiary deaths for ground ambulance transport.

Time of Death PronouncementMedicare Payment Determination
Before dispatch None
After dispatch, before beneficiary is loaded onboard ambulance and before or after arrival at the point-of-pickup The provider's/supplier's BLS base rate, no mileage or rural adjustment; submit HCPCS modifier QL
After pickup, prior to or upon arrival at the receiving facility Medically necessary level of service furnished

The following table includes scenarios for beneficiary deaths for air ambulance transport.

Time of Death PronouncementMedicare Payment Determination
Prior to takeoff, to point-of-pickup with notice to dispatcher and time to abort the flight None

Note: 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
After takeoff to point-of-pickup but before the beneficiary is loaded Appropriate air base rate with no mileage or rural adjustment; submit HCPCS modifier QL
After the beneficiary is loaded onboard, but prior to or upon arrival at the receiving facility As if the beneficiary had not died

References

 





Last Updated: 05/28/2020