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Printed Date: 9/22/2015
Palmetto GBA (Medicare) covers ambulance transportation only when transportation by any other means would endanger the patient’s health. A patient whose medical condition permits transport in any type of vehicle other than an ambulance does not qualify for ambulance coverage. It is the responsibility of the ambulance supplier to maintain (and furnish to Medicare upon request) complete and accurate documentation of the beneficiary's condition to demonstrate the ambulance service being furnished meets the medical necessity criteria. The run report should 'paint a picture' of the patient's condition at the time of transport. All documentation must be complete and legible.
The Prior Authorization Demonstration for South Carolina began on December 1, 2014 and expanded to North Carolina, Virginia and West Virginia on January 1, 2016. Ambulance suppliers that are not institutionally (hospital) based that provide Part B Medicare covered ambulance services and are enrolled as an independent ambulance suppliers will be participants. Prior authorization is a process through which a request for affirmation of coverage is submitted for review before a service is rendered to a beneficiary and before a claim is submitted for payment. Prior authorization helps ensure that applicable coverage, payment and coding rules are met before services are rendered .Please visit the Palmetto GBA website for more information regarding the Prior Authorization model.
Painting a picture of the patient’s condition begins with the run report.
Run reports must document each patient encounter. We strongly recommend that each run sheet include the following information:
Note: The HCPCS codes and diagnosis codes submitted on Medicare claims must be supported by the documentation on the run sheet.
Documentation that must be in the medical record and be made available to Medicare upon request:
Medical necessity is established when the patient's condition is such that use of any other method of transportation is contraindicated.
In general, Palmetto GBA will cover non-emergency ambulance services when it is documented that the beneficiary:
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Last Updated: 02/08/2018