Ambulance
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Spotlight
Avoid claim denial
View Medicare's billing and payment guidelines for ambulance transports of multiple patients to be sure you're providing required information.
View CMS Newsroom Center (Spotlights, news, media releases, outreach, mailing lists, etc.)
Prior authorization
Find information related to the prior authorization program for repetitive, scheduled non-emergent ambulance transport (RSNAT). Access this page for details, resources, and guidance.
Medical documentation
Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claims are accurate and based on sound policy. Find information, tips, and resources regarding medical documentation.
- Checklist: Emergent ambulance services documentation
- Ambulance trip/run sheet record documentation
- Title 42 Code of Federal Regulations CFR 424.36 -- Signature Requirements
Ambulance education
Utilize educational information from First Coast and CMS on ambulance-related services.
- Billing and Documenting Ambulance Services YouTube
- Prior authorization for RSNAT services YouTube
- Upcoming events
Visit On-Demand Learning – access First Coast’s webcast recordings, videos and tutorials.
CMS educational opportunities
Audit and compliance
- CERT resources
- Provider Compliance Tips for Ambulance Services
- Office of Inspector General (OIG) Report: Medicare Improperly Paid Providers for Nonemergency Ambulance Transports to Destinations Not Covered by Medicare
- OIG Report: Medicare Made Improper and Potentially Improper Payments for Emergency Ambulance Transports to Destinations Other Than Hospitals or Skilled Nursing Facilities
- OIG Report: Medicare Paid Twice for Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing Requirements
CMS internet-only manual (IOM)
The CMS IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives.
The following CMS manual contains information specific to ambulance providers:
- Publication 100-02 -- Medicare Benefit Policy Manual -- Chapter 10 Ambulance services
- Publication 100-04 -- Medicare Claims Processing Manual -- Chapter 15 Ambulance
- View information related to recent update – MM12707
- Publication 100-04 -- Medicare Claims Processing Manual -- Chapter 30 Section 50
Billing / coding guideline
- Request for ambulance transportation for a beneficiary in a Medicare Part A stay (Sample Notification #2)
- Ambulance Fee Schedule -- Medical Conditions List and Transportation Indicators
- Medical Conditions List
This is the original 2015 list, which was produced prior to ICD-10-CM implementation. The codes contained within are the ICD-9-CM codes. Please refer to the lists below for the current cross-walked codes. - Ambulance transports - Learn about Medicare’s billing and payment guidelines for ambulance transports of multiple patients.
- Ambulance transport – Deceased beneficiary
- Ambulance modifiers
- Ambulance mileage frequently asked questions
Resources
- Visit the Ambulance Services Center on the CMS website.
- Sections 1861(e)(1) or 1861(j)(1) of the Social Security Act
- Ambulance physician certification statement
- Listed below are additional resources identified specifically for ambulance providers:
- Listed below are resources identified specifically related to the Emergency Triage, Treat, and Transport (ET3) model:
LCD / NCD - policy information
LCD
Search for ambulance-related LCDs using these available tools:
- LCD interactive index tool
- View First Coast’s active / proposed LCDs / articles on CMS’ Medicare coverage database (MCD)
NCD
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