Effect of Beneficiary Death on Medicare Payment for Ground

10.2.6 - Effect of Beneficiary Death on Medicare Payment for Ground Ambulance Transports (Rev. 103; Issued: 02-20-09; Effective Date: 01-05-09; Implementation Date: 03- 20-09) Because the Medicare ambulance benefit is a transport benefit, if no transport of a Medicare beneficiary occurs, then there is no Medicare-covered service. In general, if the beneficiary dies before being transported, then no Medicare payment may be made. Thus, in a situation where the beneficiary dies, whether any payment under the Medicare ambulance benefit may be made depends on the time at which the beneficiary is pronounced dead by an individual authorized by the State to make such pronouncements. The chart below shows the Medicare payment determination for various ground ambulance scenarios in which the beneficiary dies. In each case, the assumption is that the ambulance transport would have otherwise been medically necessary. Ground Ambulance Scenarios: Beneficiary Death Time of Death Pronouncement Medicare Payment Determination Before dispatch. None. After dispatch, before beneficiary is loaded onboard ambulance (before or after arrival at the point-of- pickup). The provider’s/supplier’s BLS base rate, no mileage or rural adjustment; use the QL modifier when submitting the claim. After pickup, prior to or upon arrival at the receiving facility. Medically necessary level of service furnished.