A/B MAC (A) - CAH Ambulance Services - Medicare Part

100.12.2.1 - A/B MAC (A) - CAH Ambulance Services - Medicare Part B -Claims Processing (Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06) Medically necessary ambulance services originating out of an IHS CAH with a hospital- based ambulance service are submitted with revenue code 054X (ambulance) with charges for ambulance, as well as the appropriate ambulance HCPCS codes on TOB 85X. IHS CAHs that meet the 35 mile rule for cost based payment shall report condition code B2 (CAH ambulance attestation) on their bills to the A/B MAC (A). If an outpatient encounter occurs at the same time a covered ambulance service is provided, the IHS CAH may bill for a clinic visit (revenue code 051X) as well as the ambulance charges (revenue code 054X) and will be paid separately for each service. The MSN is suppressed.