Archived Policies - Administrative
Ambulance and Medical Transport Services
Ambulance services are medically necessary as outlined below:
Air or sea ambulance services are medically necessary as outlined below:
The following services are NOT medically necessary, as they do not require ambulance transportation:
Non-emergency transports are defined as ambulance transports for a patient who has a medical problem requiring treatment in another location and is so disabled that the use of an ambulance is the only appropriate means of transfer. Disabled means the patient's physical condition limits his/her mobility and is unable to stand and sit unassisted or requires continuous life support systems.
Examples of situations where non-emergency transportation is medically necessary for the patient described above include the following services:
Transfers by medical vans or commercial transportation (such as physician owned limousines, public transportation, cabs, etc.) are NOT medical transport and are not considered medically necessary.
Ambulance services involve the use of a specially designed and equipped automotive or other vehicle, licensed by the state, and regulated by local, state and federal laws, to transport the ill or injured. Ambulances can be classified as either basic life support or advanced life support depending upon how the vehicle is equipped. This in turn regulates the level of care that can be provided in the actual transport.
Basic Life Support (BLS) vehicles must be staffed by at least two people, one of whom must be certified as an emergency medical technician (EMT) by the State or local authority where the services are being furnished. The EMT must be legally authorized to operate all lifesaving and life sustaining equipment on the vehicle.
Advanced Life Support (ALS) vehicles must be staffed by two people with one of the two staff members certified as a paramedic or an EMT who is trained and certified (by the State or local authority where the services are being furnished) to perform one or more ALS service.
Coverage for ambulance service is a contract issue as well as a medical necessity issue. Ambulances are sometimes misused for non-emergency situations.This policy describes situations where it would be medically necessary and appropriate to use ALS, BLS, or non-emergency levels of ambulance services.
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
Refer to any State specific Corporate Guidelines in effect for payment information.
National Institutes of Health, NIH News Release, Education Study Increases Ambulance Use But Yields No Extra Improvement in Heart Attack Patient Delay Time. July 4, 2000.
1997 Medicare Part B Specialty Workshops, Ambulance.
BSBSA Medical Policy Reference Manual. Ambulance and Medical Transport Services. 10.01.05, (5/30/97).
|Title:||Effective Date:||End Date:|
|Ambulance and Medical Transport Services||07-01-2018||12-14-2018|
|Ambulance and Medical Transport Services||10-01-2017||06-30-2018|
|Ambulance and Medical Transport Services||12-01-2016||09-30-2017|
|Ambulance and Medical Transport Services||08-01-2016||11-30-2016|
|Ambulance and Medical Transport Services||07-15-2015||07-31-2016|
|Ambulance and Medical Transport Services||09-15-2014||07-14-2015|
|Ambulance and Medical Transport Services||08-01-2008||09-14-2014|
|Ambulance and Medical Transport Services||11-15-2007||07-31-2008|
|Ambulance and Medical Transport Services||09-15-2004||11-14-2007|
|Ambulance and Medical Transport Services||07-01-2004||09-14-2004|
|Ambulance and Medical Transport Services||11-01-1997||06-30-2004|