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Ambulance transport for Medicare Advantage HMO and PPO members receiving custodial and skilled nursing care

March 29, 2012

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This is a reminder that Medicare pays for limited ambulance transport services for Medicare Advantage HMO and PPO members receiving custodial and skilled nursing care.

For members in custodial care

Ambulance transport services are not a covered benefit for Medicare Advantage HMO and PPO members in custodial care when they are being transported to a provider?s office.

For members receiving skilled nursing care

If a Medicare Advantage HMO or PPO member who is receiving covered inpatient skilled nursing care is being transported to a provider?s office, ambulance transport services are covered only if transportation in any other vehicle could endanger the member?s health.

Please refer to Claim Payment Policy #12.04.02b: Nonemergency Ambulance Transport Services on our Medical Policy website for further information on Medicare requirements for ambulance transport services.

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