Sunday, September 19, 2010

Will Medicare pay for air ambulance transportation?



Medicare will cover transportation in an air ambulance only in limited cases. It must be medically necessary for you to receive immediate and rapid ambulance transportation that could not be provided by a ground ambulance and either:
  • A ground ambulance cannot get to where you are; or
  • There is a great distance to travel or another obstacle involved in getting you to the nearest appropriate facility.
Additionally, the air ambulance and its crew must meet Medicare requirements.


Note:In rural areas, medical necessity is automatically met if:
  • A physician or other medical professional determines that air transport is necessary due to time or geographical factors and
  • The air transport meets Medicare-approved air ambulance protocols. 

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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