Ambulance

Ambulances transport critically ill or injured passengers to hospitals, critical care hospitals and skilled nursing facilities every day. They also take patients with non-emergency conditions to and from hospitals, critical access hospitals, skilled nursing facilities, dialysis facilities and other medical facilities to treat serious health conditions. Some of these transports are scheduled in advance, and some are not. Both emergency and non-emergency ambulance transports may be covered by Medicare if specific requirements are met. 

Medicare Coverage of Ambulance Transports
Medicare Part B covers medically necessary ambulance transports to the nearest appropriate facility only when it is proven that any other means of transportation would harm your health. This coverage rule applies even if other ways of transportation are not available. 
 
Medical Necessity 
When Medicare establishes that other means of transportation would harm your health, "medical necessity" is proven. Medicare determines medical necessity by examining the notes the ambulance personnel make while documenting your trip. For non-emergency services, Medicare also requires a signed statement from your doctor indicating that you must be transported by an ambulance due to your condition.

Nearest Appropriate Facility
Medicare pays for medically necessary ambulance transports to the closest covered facility that can provide you with the level of care or services you needed. If you want to be taken farther way, Medicare will only pay the mileage to the nearest appropriate facility. You will be responsible for the excess mileage costs.

Covered facilities include hospitals, critical care hospitals and skilled nursing facilities. In some cases, transport to a dialysis facility may also be covered.

Ambulance Vehicle Requirements 
The ambulance vehicle and crew must meet Medicare requirements. Medicare does not cover transportation in any other type of vehicle including medical transport vans, wheelchair vans, taxis or other automobiles.

Advance Beneficiary Notice of Noncoverage (ABN)
Sometimes the ambulance company will ask you to sign an Advance Beneficiary Notice of Noncoverage, or ABN. They can only do this for non-emergency services, and only when they believe that Medicare won’t pay for the service. Always read an ABN carefully. An ABN explains that if you want the service, you will assume payment responsibility if Medicare doesn’t cover the transport. The ambulance company can ask you to pay at the time of the service. If you refuse to sign the ABN, the ambulance company can still transport you, but you may still be responsible for the service if Medicare doesn’t deem it medically necessary.

Non-emergency Transports
Medicare may pay for non-emergency transports by ambulance if your doctor provides a written order stating the transportation is medically necessary. Repetitive non-emergency ambulance transports are often needed by people who are receiving dialysis or cancer treatment. 

For certain non-emergency transports on and after August 1, 2022, ambulance suppliers may submit a prior authorization request to Railroad Medicare. You can find details about this on our Ambulance Prior Authorization page.

Required Documentation
To establish medical necessity, Medicare requires ambulance suppliers to submit documentation that shows any other means of transportation would have harmed your health at the time of the service. For most non-emergency services, a written doctor’s order is required. Medicare regulations also state that the presence of a signed physician’s order does not, in and of itself, prove medical necessity. It’s the total picture the ambulance company paints of what happened during the transport and why their services were needed that allows Medicare to pay.

Your Signature
In order to file the claim to Medicare, the ambulance company must obtain your signature (or that of an authorized representative). Your signature allows the ambulance company to accept Medicare assignment and also shows that you are allowing them to bill Medicare for the service. You do not have to provide your signature at the time of the transport, but you must do so within the claims filing time period (within 12 months of the date of the service).

If you or your representative refuses to sign, then the ambulance company can’t bill Medicare, and you will be responsible for the full amount of the transport. If you change your mind any time during the claims filing period, you can contact the ambulance company.

If you are unable to sign and an authorized representative can’t be found, then an ambulance employee present during the trip would need to provide a signed statement which includes:

• The date and time of the transport
• Why you were unable to sign
• An indication that no legally authorized person was available to sign on your behalf
• The name and location of the facility you were transported to

An employee from the receiving facility would also need to sign a statement that includes your name and the date and time you were brought there. If the ambulance company doesn’t get this information from the facility, with your permission, they can send Medicare a signed patient care report, your hospital registration or admission sheet or other hospital records that would support why you were not able to sign on your own.

What You Can Do If Medicare Doesn’t Pay
If Medicare denies your claim and you don’t agree, you can file an appeal. The last page of the Medicare Summary Notice (MSN) that you receive from Railroad Medicare explains your appeal rights. The page also explains how to file an appeal and gives the date that we must receive your appeal by. You can find more information about submitting an appeal in our Appeals Process article. 

If you have questions about ambulance coverage, you can call our toll-free Customer Service Line at 800–833–4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET. For the hearing impaired, call TTY/TDD at 877–566–3572.