Effect of Beneficiary Death on Program Payment for Air

10.4.9 - Effect of Beneficiary Death on Program Payment for Air 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 air ambulance scenarios in which the beneficiary dies. In each case, the assumption is that the ambulance transport would have otherwise been medically necessary. If the flight is aborted for other reasons, such as bad weather, the Medicare payment determination is based on whether the beneficiary was onboard the air ambulance. Air Ambulance Scenarios: Beneficiary Death Time of Death Pronouncement Medicare Payment Determination Prior to takeoff to point-of-pickup with notice to dispatcher and time to abort the flight. None. NOTE: This scenario includes situations in which the air ambulance has taxied to the runway, and/or has been cleared for takeoff, but has not actually taken off.) After takeoff to point-of-pickup, but before the beneficiary is loaded. Appropriate air base rate with no mileage or rural adjustment; use the QL modifier when submitting the claim. After the beneficiary is loaded onboard, but prior to or upon arrival at the receiving facility. As if the beneficiary had not died.