In general, Medicare & Medicaid will cover medically necessary ambulance transportation to the nearest appropriate medical facility. Emergency ambulance transportation may qualify for Medicare coverage if the transport is a result of a sudden onset of a medical condition or traumatic injury manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, impairment to bodily function, or serious dysfunction to any bodily organ or part.
Medicare requires that ambulance transportation be medically necessary and reasonable.
Download: Medicare Coverage of Ambulance Services (PDF)
- If you choose to be transported to a specific facility, Medicare’s payment will be based on the payment rate to the closest appropriate facility. The patient must pay for the balance of the trip.
- If no local facilities are able to give you the care you need, Medicare will help pay for transportation to the nearest appropriate facility outside of your local area.
- Medicare won’t pay transportation from one facility to another so you can be closer to your home or family.
- If Medicare doesn’t cover your ambulance trip and you think it should have been covered, you have a right to appeal. Review your Medicare Summary Notice (MSN) to find out what appeal steps you can take.
- If you are in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, what you pay and the rules for ambulance coverage maybe different. Read your plan materials or call your benefits administrator for more information.
Question: I was recently transported by ambulance and Medicare denied my bill for medical necessity. Why did they deny payment and what are my rights?
Answer: The Medicare program will only pay for ambulance services that it deems are medically necessary. In all cases, other means of transportation must be contraindicated due to the patient’s condition, regardless of whether other means of transportation are available. The patient’s condition must be acute and such that transport by other means would endanger the patient’s life, limb or bodily organs.
A patient has the right to appeal Medicare’s decision. In the event that a patient’s bill is rejected, they can file an appeal for reconsideration. Simply obtain all of the information in regards to the service provided (i.e. ambulance records, emergency room records, physician notes, discharge orders, etc.) and mail them to the Medicare carrier requesting an appeal.