Medicare Coverage
of Ambulance Services
This official government booklet
explains:
When Medicare helps cover
ambulance services
What you pay
What Medicare pays
What to do if Medicare doesn’t
cover your ambulance service
CENTERS for MEDICARE
& MEDICAID SERVICES
Table of contents
Medicare coverage of ambulance services . . . . . . . . . . 5
Emergency ambulance transportation . . . . . . . . . . . . . . . . 5
Air transportation . . . . . . . . . . . . . . . . . . . . . . . . . 6
Non-emergency ambulance transportation . . . . . . . . . . . . . . 6
“Advance Beneficiary Notice of Noncoverage” (ABN) . . . . . . 7
Voluntary ABN . . . . . . . . . . . . . . . . . . . . . . . 8
Paying for ambulance services . . . . . . . . . . . . . . . . . 9
What do I pay? . . . . . . . . . . . . . . . . . . . . . . . . . . 9
What does Medicare pay? . . . . . . . . . . . . . . . . . . . . . . 9
How do I know if Medicare didn’t pay for my ambulance service? . . . . 9
Medicare rights & protections . . . . . . . . . . . . . . . . .11
What can I do if Medicare doesn’t pay for an ambulance trip? . . . . . .11
What if Medicare still won’t pay? . . . . . . . . . . . . . . . . . 12
4
“Medicare Coverage of Ambulance Services” isn’t a legal document.
Ocial Medicare Program legal guidance is contained in the relevant
statutes, regulations, and rulings.
e information in this booklet describes the Medicare Program at the
time this booklet was printed. Changes may occur aer printing. Visit
Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the
most current information. TTY users can call 1-877-486-2048.
e information in
this booklet applies
to all people with
OriginalMedicare.
If you have a Medicare
Advantage Plan or other
Medicare health plan,
you have the same basic
benets, but the rules
vary by plan. Your costs,
rights, protections, and
choices about where you
can get your care may
be dierent. For more
information, read your
plan materials or call
your plan.
5
Medicare coverage of ambulance services
Medicare Part B (Medical Insurance) covers ambulance services to
or from a hospital, critical access hospital (CAH), rural emergency
hospital (REH), or a skilled nursing facility (SNF). Medicare
covers and helps pay for ambulance services only when other
transportation could endanger your health, like if you have a health
condition that requires this type of transportation.
In some cases, Medicare may also cover ambulance services if you
have End-Stage Renal Disease (ESRD) (permanent kidney failure
requiring dialysis or a kidney transplant), or you need dialysis and
need ambulance transportation to or from a dialysis facility.
Medicare will only cover ambulance services to the nearest
appropriate medical facility that can give you the care you need.
If you choose to be transported to a facility farther away, Medicare
will only pay up to what it costs to take you to the closest facility
that can give you the care you need. If no local facilities can to give
you the care you need, Medicare will pay for transportation to the
nearest facility outside your local area that can give you necessary
care.
Emergency ambulance transportation
You can get emergency ambulance transportation when you’ve had
a sudden medical emergency, your health is in serious danger, and
you can’t be safely transported by other means, like by car or taxi.
Medicare might cover emergency ambulance transportation when:
■ You’re in shock, unconscious, or bleeding heavily.
■ You need skilled medical treatment during transportation.
Remember, these are only examples. Medicare coverage depends
on the seriousness of your medical condition and if you could’ve
been safely transported by other means.
6 Medicare coverage of ambulance services
Air transportation
Medicare may pay for emergency ambulance transportation in an airplane or
helicopter if your health condition requires immediate and rapid ambulance
transportation that ground transportation can’t provide, and one of these applies:
■ Your pickup location can’t be easily reached by ground transportation.
■ Long distances or other obstacles, like heavy trac, could stop you from
getting care quickly ifyou traveled by ground ambulance.
Non-emergency ambulance transportation
You may be able to get non-emergency ambulance transportation if you
need it to treat or diagnose your health condition and the use of any other
transportation method could endanger your health.
In some cases, Medicare may cover limited, medically necessary, non-emergency
ambulance transportation if your doctor writes an order stating that you need
ambulance transportation due to your medical condition. Even if a situation isn’t
an emergency, ambulance transportation may be medically necessary to getyou to
a hospital or other covered health facility.
Medicare prior authorization program
If you get scheduled, non-emergency ambulance transportation for 3 or
more round trips in a 10-day period or at least once a week for 3 weeks or
more, you may be aected by a Medicare prior authorization program.
Under this program, your ambulance company may send a request for
prior authorization to Medicare, so you and the company will know
earlier in the process if Medicare is likely to cover your services. e
Medicare benet isn’t changing.
Either you or your ambulance company may request prior
authorization for these repeated, scheduled, non-emergency
ambulance services. If your prior authorization request isn’t approved
and you continue getting these services, Medicare will deny the claim
and the ambulance company may bill you for all charges. For more
information, call 1-800-MEDICARE (1-800-633-4227). TTY users can
call 1-877-486-2048. Visit Medicare.gov/coverage/ambulance-services
for the latest updates on the Medicare prior authorization program.
7Medicare coverage of ambulance services
“Advance Beneficiary Notice of Noncoverage” (ABN)
When you get ambulance services in a non-emergency situation, the
ambulance company considers if Medicare may cover the transportation.
If Medicare would usually cover the transportation, but the ambulance
company believes that Medicare may not pay for your particular
ambulance service because it isn’t medically reasonable and necessary, it
must give you an “Advance Beneciary Notice of Noncoverage” (ABN)
to charge you for the service. e ambulance company won’t ask you to
sign an ABN in an emergency. An ABN is notice that a doctor, supplier,
or provider gives you before furnishing an item or service if they believe
that Medicare may deny payment.
ABNs have options that allow you to choose if you want the service and
explain your responsibility to pay for the service. If you choose the option
showing that you want and will pay for the service, and you sign the ABN,
you’re responsible for paying if Medicare doesn’t. e ambulance provider
or supplier may ask you to pay at the time of service.
Example: Mr. Smith is a hospital inpatient and needs to travel to
a dierent hospital for a procedure that he can’t get in the hospital
where he was admitted. Mr. Smith requires ground ambulance
transportation because of his medical conditions, but he asks for air
ambulance transportation
instead. Medicare will cover the
cost of the ground ambulance
transportation, but won’t cover
air ambulance transportation
because this level of service isn’t
medically reasonable or necessary.
eambulance company
must give Mr. Smith an ABN
before transporting him by air
ambulance, or the ambulance
company will be responsible
for any costs over the amount
that Medicare would’ve paid for
ground ambulance transportation.
8 Medicare coverage of ambulance services
Note: If you’re in a situation that requires an ambulance
company to give you an ABN and you refuse to sign it, the
ambulance company will decide whether to take you by
ambulance. If the ambulance company decides to take you and
Medicare doesn’t pay, you may still be responsible for the cost of
the trip, even though you refused to sign the ABN.
Voluntary ABN
If an ambulance company believes that Medicare won’t cover an
ambulance service because it doesn’t meet Medicare’s denition
of a covered service, it may give you a voluntary ABN as a
courtesy. In this situation, the ambulance company isn’t required
to give you an ABN to bill you for the service. If the ambulance
company gives you a voluntary ABN, you aren’t required to
choose an option or sign it. Inthis situation, the ambulance
company expects that Medicare won’t pay for the service, and
you’ll be nancially responsible.
Example: Mrs. Lee falls in her front yard and her neighbor
calls an ambulance. She isn’t in distress, but she can’t stand
up without having ankle pain. When the ambulance arrives,
Mrs.Lee wants to go to the hospital, but she doesn’t have a
serious medical emergency and her health won’t be in danger
if she goes to the emergency room another way (like a car or
taxi). Since Mrs. Lee could get to the hospital by another type
of transportation without a serious risk to her health, Medicare
won’t cover the ambulance transportation. In this situation, the
ambulance company isn’t required to give Mrs. Lee any formal
notice, but out of courtesy, they may give her an ABN, so that
she knows she’ll be billed for this service.
If Medicare doesn’t pay for your ambulance trip and you believe
it should have, you may appeal. Youmust actually get the service
and a claim for payment must be submitted to appeal Medicare’s
payment decision. Go topages11–12 for information.
9
Paying for ambulance services
What do I pay?
If Medicare covers your ambulance trip, you pay 20% of the
Medicare-approved amount aer you’ve 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. All ambulance companies must accept the
Medicare-approved amount as payment in full. Note: If a
critical access hospital (CAH) or an entity owned and operated
by a CAH transports you, what you and Medicare pay may be
dierent.
What does Medicare pay?
If Medicare covers your ambulance trip, Medicare will pay
80% of the Medicare-approved amount aer you’ve met the
yearly Part B deductible. Medicare’s payment may be dierent
if you’re transported by a CAH or an entity that’s owned and
operated by aCAH.
How do I know if Medicare didn’t pay for my ambulance
service?
You’ll get a “Medicare Summary Notice” (MSN) in the mail
every 3 months that lists all the services billed to Medicare,
including ambulance services. Or, visit Medicare.gov to log
into (or create) your secure Medicare account to check your
Medicare claims or view monthly electronic MSNs. Your MSN
will tell you why Medicare didn’t pay for your ambulance trip.
10
MSN examples for why Medicare didn’t pay for your ambulance
trip:
■ You chose to go to a facility farther than the closest one, so
your notice says: “Payment for transportation is allowed only to
the closest facility that can provide the necessary care.”
■ You used an ambulance to move from one facility to another
one closer to home, so your notice says: “Transportation to a
facility to be closer to a home or family is not covered.”
Remember, these are only examples of statements you may nd
on your MSN. Statements vary depending on your situation. If
you have questions about what Medicare paid, call the phone
number on your MSN or 1-800-MEDICARE (1-800-633-4227).
TTY users can call 1-877-486-2048.
Paying for ambulance services
11
Medicare rights & protections
What can I do if Medicare doesn’t pay for an ambulance trip?
If Medicare doesn’t pay for an ambulance trip that you think should be
covered, you or someone you trust can review your Medicare Summary
Notice (MSN) and any other paperwork related to your ambulance bill.
You may nd errors that can be xed.
For example, while reviewing your MSN and other paperwork, you may
nd that Medicare denied your claim for one of these reasons:
■ e ambulance company didn’t fully document why you needed
ambulance transportation.
If this happens, you can contact the doctor who treated you or the
discharge social worker to get more information about your need
for ambulance transportation. You can send this information to the
company that handles bills for Medicare or ask your doctor to send it.
Look on your MSN for the company’s address.
■ e ambulance company didn’t le the proper paperwork.
If this happens, you can ask the ambulance company to rele your
claim. If reling your claim doesn’t result in payment, you can le an
appeal.
12
What if Medicare still won’t pay?
If you have Medicare, you have certain guaranteed rights, including the
right to appeal decisions about payment or coverage of services.
If Medicare doesn’t cover your ambulance trip, and you think your trip
should’ve been covered, you have the right to appeal. An appeal is an
action you take if you disagree with a coverage or payment decision
Medicare makes. To le an appeal, follow these steps:
1. Review your “Medicare Summary Notice” (MSN). It will tell you
why your bill wasn’t paid, how long you have to le an appeal, and
what steps you need to take.
2. Carefully follow the instructions on the MSN, sign it, and send it to
the address of the company on the rst page of the MSN. You may
also include a letter explaining why you believe the ambulance trip
should’ve been covered.
3. Ask your doctor or health care provider for any information that
may help your case and attach copies to your signed MSN.
4. Keep a copy of everything you send to Medicare as part of your
appeal.
Or, you can use CMS Form 20027 and le it with the Medicare
contractor at the address listed on the MSN. To view or print this
form, visit CMS.gov/cmsforms/downloads/cms20027.pdf, or call
1-800-MEDICARE (1-800-633-4227) to nd out if a copy can be mailed
to you. TTY users can call 1-877-486-2048.
If you need more information or help ling an appeal:
■ Visit Medicare.gov/claims-appeals/how-do-i-le-an-appeal.
■ Call your State Health Insurance Assistance Program (SHIP). Visit
shiphelp.org, or call 1-800-MEDICARE to get the phone number.
Medicare rights & protections
13
CMS Accessible Communications
e Centers for Medicare & Medicaid Services (CMS) provides free auxiliary aids and
services, including information in accessible formats like braille, large print, data or
audio les, relay services and TTY communications. If you request information in
an accessible format from CMS, you won’t be disadvantaged by any additional time
necessary to provide it. is means you’ll get extra time to take any action if there’s a
delay in fullling your request.
To request Medicare or Marketplace information in an accessible format you can:
1. Call us: For Medicare: 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048.
2. Send us a fax: 1-844-530-3676.
3. Send us a letter:
Centers for Medicare & Medicaid Services
Oces of Hearings and Inquiries (OHI)
7500 Security Boulevard, Mail Stop DO-01-20
Baltimore, MD 21244-1850
Attn: Customer Accessibility Resource Sta (CARS)
Your request should include your name, phone number, type of information you need (if
known), and the mailing address where we should send the materials. We may contact
you for additional information.
Note: If you’re enrolled in a Medicare Advantage Plan or Medicare Drug Plan, contact
your plan to request its information in an accessible format. For Medicaid, contact your
State or local Medicaid oce.
14
This product was produced at U.S. taxpayer expense.
Nondiscrimination Notice
e Centers for Medicare & Medicaid Services (CMS) doesn’t exclude, deny benets
to, or otherwise discriminate against any person on the basis of race, color, national
origin, disability, sex (including sexual orientation and gender identity), or age in
admission to, participation in, or receipt of the services and benets under any of its
programs and activities, whether carried out by CMS directly or through a contractor
or any other entity with which CMS arranges to carry out its programs and activities.
You can contact CMS in any of the ways included in this notice if you have any
concerns about getting information in a format that you can use.
You may also le a complaint if you think you’ve been subjected to discrimination in
a CMS program or activity, including experiencing issues with getting information
in an accessible format from any Medicare Advantage Plan, Medicare drug plan,
state or local Medicaid oce, or Marketplace Qualied Health Plans. ere are three
ways to le a complaint with the U.S. Department of Health and Human Services,
Oce for Civil Rights:
1. Online: https://www.hhs.gov/civil-rights/ling-a-complaint/index.html.
2. By phone: Call 1-800-368-1019. TTY users can call 1-800-537-7697.
3. In writing: Send information about your complaint to:
Oce for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
is product is available in Spanish. To get a free
copy, call 1-800-MEDICARE (1-800-633-4227).
TTY users can call 1-877-486-2048.
Esta publicación está disponible en Español.
Para obtener una copia gratis, llame al
1-800-MEDICARE (1-800-633-4227). Los
usuarios de TTY deben llamar al 1-877-486-2048.
U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-1850
Ocial Business
Penalty for Private Use, $300
CMS Product No. 11021
Revised August 2023
