If an ambulance is dispatched as a result of a 911 call, arrives at the scene, does an assessment of the patient and it is found there is no need for the transport, would the Advanced Beneficiary Notice (ABN) be used in this case if we intend to bill the patient?

Answer
No. The Medicare ambulance benefit is a transport benefit and if there is no transport in this situation, then there is no benefit. Therefore, it is a non-covered service. An Advance Beneficiary Notice (ABN) is not required since this service is specifically non-covered and there is no medical necessity for ambulance transport. Accordingly, HCPCS code A0999 with the GY HCPCS modifier would be the appropriate modifier for a non-covered service where the beneficiary is liable for the payment.

Resources
Centers for Medicare & Medicaid Services FFS ABN page

CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, chapter 30 (PDF, 1.16 MB), section 50.15.2

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