Billing Medicare for Ambulance Transports

In a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number of key problems, including:

• Ambulance transports for beneficiaries who did not receive any Medicare services at the point of origin or destination
• Transports to noncovered destinations
• Excessive mileage reported on claims for urban transports
• Medically unnecessary transports to partial hospitalization programs
• Inappropriate transport service levels

Review the following resources to bill correctly for this service:

• OIG Report: Inappropriate Payments and Questionable Billing for Medicare Part B Ambulance Transports
• Medicare Benefit Policy Manual: Chapter 10 – Ambulance Service
• Medicare Benefit Policy Manual: Chapter 15 - Ambulance
• 42 CFR 410.40: Coverage of Ambulance Services
• 42 CFR 410.41: Requirements for Ambulance Suppliers
• 42 CFR 410.41: Definitions
• 42 CFR 414.610: Basis of Payment
• Ambulance Fee Schedule website
• Ambulance Fee Schedule Fact Sheet
• Medicare Ambulance Transports Booklet
• CMS Transmittal 9620