Ambulance Services - No Transport
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
The following shows the Medicare Advantage coverage determination for various ground ambulance scenarios in which the member expires. In each case, the assumption is the ambulance transport would have otherwise been medically necessary.
| Scenario | Coverage Determination |
|---|---|
Time of Death Pronouncement (by an individual authorized by the state to make such pronouncements) |
Medicare Payment Determination |
Before dispatch |
The service is not covered |
After dispatch, before member is loaded onboard the ambulance (before or after arrival at the point-of-pickup) |
The provider's or supplier's basic life support (BLS) base rate, no mileage or rural adjustment; use the QL modifier (member died after ambulance was called) when submitting the claim |
After pickup, prior to or upon arrival at the receiving facility |
Medically necessary level of service furnished |