Medicare states non-emergency ambulance transports are considered medically necessary when the patient’s medical condition is such that the use of any other method of transportation (e.g., taxi, private car, wheelchair coach) would be medically contraindicated (e.g., would endanger the patient’s medical condition).
The lack of an available alternate mode of transportation (e.g., taxi, bus, personal car) or the inability to drive does not satisfy the medically necessary requirements. Non-emergency ambulance transport for convenience or because another means of transportation is not available is not considered medically necessary, and, therefore not covered.
If you or your patient requires repetitive transports (Dialysis, Wound Care, ect), a patient evaluator from our billing company ABRS will come out to evaluate which mode of transportation fits the needs of the patient.
Medicare Part B covers ambulance transportation. Non-emergency transports to and from Hospitals (excluding Dr. appts), Dialysis, Nursing Homes, and Beneficiaries’ homes, can be a Medicare covered service, if the transport is medically reasonable and necessary. ***Medicare does NOT cover transportation to Doctor Appointments, Medical Office Buildings, or Diagnostic centers or Wheelchair transports.
If Medicare covers your ambulance trip, it will pay 80% of the Medicare-approved amount after you have met the yearly Part B deductible.
If Medicare covers your ambulance trip, you pay 20% of the Medicare-approved amount, after you have met the yearly Part B Deductible. In most cases, the ambulance company can’t charge you more than 20% of the Medicare-approved amount and any unmet Part B deductible.
Coverage of ambulance transportation by insurance carriers may vary materially based upon a patient’s individual policy. It is the policy holder’s responsibility to know what their policy covers. Please check with your carrier to verify your coverage.
You must call your insurance provider first, they will set up transportation for you.
Anthem Medicaid call 1-866-288-3133https://mss.anthem.com/in/benefits/transportation-services.html
MHS CALL 1-877-647-4848 After you are directed to the member prompt, say “transportation.” You can speak to a live transportation representative between 8 a.m. - 8 p.m. Monday through Friday. Transportation is scheduled through a message system after hours and on weekends. All messages are returned within one day.
MDWISE CALL 1-800-356-1204 and choose the transportation option. You should call MDwise to arrange a ride the same day you call for your appointment.
CARESOURCE CALL 1-800-488-0134 *** Healthy Indiana Plan (HIP) members are not covered for non-emergency transportation.
Individuals are required to sign the PCR (Patient Care Report) along with any Medicare beneficiary form provided at the time of transport. You are required to provide signatures acknowledging consent for treatment and transportation. With this signature, ABRS is authorized to submit a bill on your behalf, assign benefits to the transportation provider allowing your medical insurance carrier to pay them directly, and acknowledge you have received the transportation provider’s Privacy Practices Notice. We cannot submit a claim to a medical insurance carrier without a signed authorization from the patient or guardian. Failure to provide a signed authorization of the patient may require ABRS to seek payment directly from the patient or guarantor.