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Ambulance Payment Medicare Rules in Pennsylvania

The section of Medicare that pays for ambulatory services is found under Part B: Benefits. Medicare only covers limited ambulance services, which means that Medicare will only pay if transportation in "any other vehicle would endanger your health." Deciphering the Pennsylvania ambulance payment rules for Medicare can be be confusing because of all the legal jargon used.

  1. Vehicle and Crew Regulations

    • Any vehicle used as an ambulance must be designed and equipped to respond to medical emergencies. If using a vehicle such as a wheelchair van transport, it must be designated as such and follow the same rules.

      Each vehicle must comply with state and local laws as well as have a valid license as a emergency medical transportation vehicle.

      Bare minimum requirements include a stretcher, linen, emergency medical supplies, oxygen tools, emergency warning lights and sirens and a two-way voice radio or wireless telephone. If these minimums are not met, Medicare will deny service and payment.

    Location

    • Medicare will only help pay for the closest facility that can provide the level of care needed by the patient. If the patient chooses a facility further away, payment will be based on how much it would cost to go to the closest facility.

      This means that if the closest facility is not your first choice but is at the level of care needed, Medicare will charge appropriately for each mile driven in order to go to your preferred facility.

      Generally, Medicare does not pay for ambulance transportation to a doctor's office.

    Air-Ambulance

    • Air ambulances, also known as helicopter ambulances, are approved in only the most severe situations. You will be responsible for the difference if a land ambulance could have been used without serious danger to your life and/or health.

    Death

    • Medicare will not pay if the patient is pronounced dead before the ambulance is called.

      If a patient is pronounced dead after the ambulance is called and before or after the ambulance arrives, Medicare will pay for basic life support with no billable mileage.

      If the patient is pronounced dead after being loaded into the ambulance, Medicare rules state that regardless of whether the announcement was made during or after the transport, it will pay as if the patient had not died. A proper "dead on arrival" (DOA) announcement must be made by an individual authorized under state law.

    Base Rates

    • Medicare will pay a base rate for transportation that includes supplies and services rendered. A separate charge is made for mileage.

    Payment Out of Pocket

    • You will be responsible to pay for 20 percent of any Medicare-approved amounts billed.

      You must also pay an annual deductible, as of 2010, of $155 in order to cover ambulance services and supplies before Medicare will begin to pay out.

    Important Information

    • Actual amounts you must pay may be higher if a doctor, health care provider or medical supplier does not accept the ambulatory assignment. Check with your Medicare provider to see if this is the case.

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