Medicare Regulations for Ambulance Service

If you suffer from a medical emergency such as a heart attack or an accident resulting in severe injuries, do not hesitate to call for an ambulance. Medicare will cover the cost of the transportation for its patients in emergency situations. Medicare even covers some of the cost of limited non-emergency transportation to the hospital.

Medical Necessity

• For Medicare to cover the cost of an ambulance service (minus whatever you owe as a deductible) you must meet two requirements. First, transportation to the hospital in any vehicle other than an ambulance would negatively affect your immediate health or medical condition. Second, your immediate medical condition must require the services and attention of the paramedics. Only then will Medicare consider the cost of your ambulance service medically necessary.

Non-Emergency Transportation

• In certain situations Medicare will cover 80 percent of the ambulance services cost you incur when your need for transportation was not a medical emergency. However, you must be bedridden or have your doctor schedule the ambulance service beforehand. Your doctor must also provide a written statement indicating why ambulance services are a medical necessity. Medicare considers you bed-confined if you are unable to get out of bed without assistance, walk or sit in a chair or wheelchair. When your doctor schedules your ambulance service in this situation he must do so at least 60 days before the date of transportation.

Special Rules

• It is possible for Medicare to cover your non-emergency, unscheduled ambulance services if you are a resident of a medical facility and under the care of a doctor. This type of ambulance service includes getting X-rays or brain scans performed at another facility when your current medical facility is unable provide such services. Your doctor must provide a written note stating the medical necessity for this kind of ambulance service to the provider within 48 hours after the transportation.

Types of Ambulance Services

• Ambulances, airplanes and helicopters all fall under the category of ambulance services. While ambulances are the most typical methods used for medical emergencies, Medicare will cover the costs of aerial transportation if an ambulance cannot provide the immediate and quick service that your medical condition requires.