Reasonable and Necessary Services

6.4.4 – Reasonable and Necessary Services (Rev. 308, Issued: 10-30-09, Effective: 11-30-09, Implementation: 11-30-09) When data analysis indicates, fiscal intermediaries, carriers, or MACs may perform medical review of rural air ambulance claims in those instances noted in the above paragraph where there is financial or employment relationship between the person requesting an air ambulance transport and the person providing the service. The fiscal intermediaries, carriers, or MACs may also conduct medical review of rural air ambulance claims with “deemed” medical necessity status when there are questions as to whether the transport was made pursuant to a protocol which has been approved by the Secretary; or questions as to whether the transport was inconsistent with an approved protocol. Medicare payment can be made only to the closest facility capable of providing the care needed by the beneficiary irrespective of whom orders the transport.