Sunday, September 19, 2010

Medicare ambulance transportation coverage and guidelines

Does my doctor have to certify that I need ground ambulance transportation?


A doctor does not have to certify that your health requires ground ambulance transportation if it is an emergency. For non-emergency ground transportation, doctor certification may be needed, but it depends on your circumstances.

If you want to schedule regular ambulance trips, your doctor must send the supplier a written order ahead of time. The order can be dated no earlier than 60 days before the trip.


For irregular or unscheduled or trips, your doctor must send a written order to the supplier within 48 hours if you are in a SNF and are under the care of a doctor. If you are at home or in a facility where you are not under the direct care of a doctor, a doctor certification is not required. 
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download