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.