Medicare Guidelines For Ambulance Transportation

The following are qualifiers for Medicare APPROVED transports by ambulance.
1. Any emergency situation.
2. Restraints required - with explanation.
3. Unconsciousness or shock.
4. Paralysis - Full or partial with cause and areas of the body affected.
5. Hemorrhage - Profuse, severe uncontrolled bleeding.
6. Can only be moved by stretcher.
7. Convulsions.
8. Spinal Injury.
9. Oxygen is required.
10. Required emergency treatment - what treatment was provide.
11. Acute or complete stroke.
12. Myocardial infarction.
13. Patient confined to bed 18 hours minimum per day, before and after transportation.
14. Patient died in the ambulance or enroute to the hospital.

The following are ambulance transports that are NOT approved by Medicare
1. Patient using a walker, wheelchair or an ambulette.
2. Doctor ordered an ambulance but patient does not meet criteria as listed above.
3. Intoxication.
4. Handling a disturbed patient unless restraints are used for patient's protection.
5. Severe illness not included as listed in above criteria.
6. Possible GI bleed - OK for an emergency, but not for return or discharge.
7. Too sick to walk - OK if bed confined as outlined in #13 listed above.
8. Leg cast - OK if patient can only be moved by stretcher.
9. Maintenance dialysis - Must have an approved condition.
10. Fractured arm - Must have an approved condition.
11. Nausea/Vomiting -  Must have an approved condition.
12. Heart Condition - Must have an approved condition.
13. Rule out a condition - Must have an approved condition.
14. Patient died prior to call for an ambulance.
15. Blindness -  Must have an approved condition.
16. Arthritis - Must have an approved condition.
17. Patient transported due to physician, family or patient preference.

If you have any questions concerning the above guidelines, please call Stark-Summit 1-800-870-9814 and ask for the billing department.