Ambulance transport – Deceased beneficiary
Because the Medicare ambulance benefit is a transport benefit, if no transport of a Medicare beneficiary occurs, there is no Medicare-covered service.
In general, if the beneficiary dies before being transported, then no Medicare payment may be made. In a situation where the beneficiary dies, payment under the Medicare ambulance benefit depends on the time at which the beneficiary is pronounced dead by an individual authorized by the State to make such pronouncements.
Ground ambulance
The assumption is that the ambulance transport would have otherwise been medically necessary.
| Time of death pronouncement | Payment/No payment | Required modifier |
|---|---|---|
| Before dispatch | No payment | N/A |
| After dispatch but before beneficiary is loaded onboard ambulance (before or after arrival at point of pick up). |
Payment will be made based on the basic life support rate, A0428 (BLS) non- emergency or A0429 (BLS) emergency transport. No payment for mileage or rural adjustment. |
Part B Supplier's billing on the CMS-1500 claim form or the electronic equivalent will require the QL-Patient pronounced dead after ambulance called. Origin and destination modifiers should not be reported. Institutional-based providers billing on the Part A UB-04 form or the electronic equivalent must report mileage code with $1.00 in non-covered. Institutional providers require the QL and one of the arrangements modifiers. QM-Ambulance service provided under arrangement by a provider of services. or QN-Ambulance service furnished directly by a provider of services. Origin and destination modifiers should not be reported. |
| After pickup; prior to or upon arrival at receiving facility. | Payment based on the medically necessary of service furnished. | Submit the appropriate origin and destination modifiers. |
Air ambulance
The assumption is that the ambulance transport would have otherwise been medically necessary.
| Time of death pronouncement | What is paid/not paid | Required modifier |
|---|---|---|
| Prior to takeoff to point of pickup with notice to dispatcher and time to abort flight. | No payment. | N/A |
| After takeoff to point of pickup; but before beneficiary is loaded. |
Payment for air base rate. A0430 - Ambulance service, conventional air services, transport, one way, fixed wing or A0431 - Ambulance service, conventional air services, transport, one way, rotary wing. No payment for mileage or rural adjustment. |
Part B Supplier's billing on the CMS-1500 claim form or the electronic equivalent will require the QL-Patient pronounced dead after ambulance called. Origin and destination modifiers should not be reported. Institutional-based providers billing on the Part A UB-04 form or the electronic equivalent must report mileage code with $1.00 in non-covered. Institutional providers require the QL and one of the arrangements modifiers. QM-Ambulance service provided under arrangement by a provider of services. or QN-Ambulance service furnished directly by a provider of services. Origin and destination modifiers should not be reported. |
| After the beneficiary is loaded onboard; but prior to or upon arrival at receiving facility. | Payment based on the medically necessary of service furnished. | Submit the appropriate origin and destination modifiers. |