Air Ambulance

20.3 - Air Ambulance (Rev. 3380, Issued: 10-23-15, Effective: 01-01-16, Implementation: 01-04-16) Refer to IOM Pub. 100-02, Medicare Benefit Policy Manual, chapter 10 - Ambulance Services, section 10.4 – Air Ambulance Services, and section 30.1.2 – Definitions of Air Ambulance Services for additional information on the coverage and definitions of air ambulance services. Under certain circumstances, transportation by airplane or helicopter may qualify as covered ambulance services. If the conditions of coverage are met, payment may be made for the air ambulance services. Air ambulance services are paid at different rates according to two air ambulance categories: • AIR ambulance service, conventional air services, transport, one way, fixed wing (FW) (HCPCS code A0430) • AIR ambulance service, conventional air services, transport, one way, rotary wing (RW) (HCPCS code A0431) Covered air ambulance mileage services are paid when the appropriate HCPCS code is reported on the claim: • HCPCS code A0435 identifies FIXED WING AIR MILEAGE • HCPCS code A0436 identifies ROTARY WING AIR MILEAGE Effective for claims with dates of service on or after January 1, 2011, air mileage must be reported in fractional numbers of loaded statute miles flown. Contractors must ensure that the appropriate air transport code is used with the appropriate mileage code. Air ambulance services may be paid only for ambulance services to a hospital. Other destinations e.g., skilled nursing facility, a physician’s office, or a patient’s home may not be paid air ambulance. The destination is identified by the use of an appropriate modifier as defined in Section 30(A) of this chapter. Claims for air transports may account for all mileage from the point of pickup, including where applicable: ramp to taxiway, taxiway to runway, takeoff run, air miles, roll out upon landing, and taxiing after landing. Additional air mileage may be allowed by the contractor in situations where additional mileage is incurred, due to circumstances beyond the pilot’s control. These circumstances include, but are not limited to, the following: • Military base and other restricted zones, air-defense zones, and similar FAA restrictions and prohibitions; • Hazardous weather; or • Variances in departure patterns and clearance routes required by an air traffic controller. If the air transport meets the criteria for medical necessity, Medicare pays the actual miles flown for legitimate reasons as determined by the Medicare contractor, once the Medicare beneficiary is loaded onto the air ambulance. IOM Pub. 100-08, Medicare Program Integrity Manual, chapter 6 – Intermediary MR Guidelines for Specific Services contains instructions for Medical Review of Air Ambulance Services.