Ambulance and Medical Transport Services
DESCRIPTION
Ambulance and medical transport services involve the use of specially designed and equipped vehicles to transport ill or injured individuals. These services may involve ground, air, or sea transport in both emergency and non-emergency situations.
POLICY
Ground emergency medical transport service is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Air or sea ambulance service is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Non-emergency medical transport service is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
Ground emergency medical transport is considered medically appropriate if all the following criteria are met:
The medical transport services comply with all local, state, and federal laws. They must have all the appropriate and valid licenses / permits; and
The ambulance or other medical transport services must have the necessary patient care equipment and supplies; and
The individual has a medical or surgical emergency and any other form of transportation would be medically contraindicated; and
The individual requires transport to the nearest hospital with the appropriate facilities to treat the illness or injury. Transfer to the nearest hospital is required to provide appropriate care (e.g., organ transplantation).
Air or sea ambulance service is considered medically appropriate if all of the above criteria for ground transportation are met in addition to any one of the following criteria:
The individual's medical condition requires immediate and rapid ambulance transport that can not be provided by a land ambulance; or
The point of pick up is inaccessible by a land vehicle; or
Great distances, limited time frames, or other obstacles are involved in getting the individual to the nearest hospital with appropriate facilities for treatment, (e.g., transport of a critically ill individual to an approved transplant facility with a waiting organ); or
The condition is such that the time needed to transport by land poses a threat to the individual's health.
Non-emergency medical transport service is considered medically appropriate when all the following criteria are met:
The medical transport services comply with all local, state, and federal laws. They must have all the appropriate and valid licenses / permits; and
The individual is registered as an inpatient of an acute care hospital, and the specialized services are not available in that hospital.
Ambulance and medical transport services are considered not medically appropriate for, but not limited to, the following conditions:
An ambulance is dispatched and the individual does not use the service; or
Advanced life-support (ALS), basic life-support (BLS), or two-tiered services are used for the individual when transported to a physician's office, outpatient department of a hospital for medical care, or the individual's home; or
Two-tiered services are used in a non-emergency situation; or
When services are provided as a convenience rather than a medical necessity; or
Air ambulance services from islands and other areas for the sake of individual and family preferences rather than medical necessity.
ADDITIONAL INFORMATION
Approved Ambulance Transport Services:
BASIC LIFE SUPPORT (BLS)
BLS provides techniques and skills included in an emergency medical technician (EMT) basic training course to individuals as they are transported to the nearest hospital.
ADVANCED LIFE SUPPORT (ALS)
ALS provides sophisticated medical care, such as cardiac monitoring, defibrillation, management of pediatric and obstetrical emergencies, and stabilization of individuals in critical or life-threatening conditions as they are transported to the nearest hospital. The ALS ambulatory emergency medical technicians receive medical directions via radio contact with a hospital-based physician.
TWO-TIERED AMBULANCE (Extra Paramedic) SERVICES
Occurs when a BLS ambulance provider responds to an emergency situation requiring ALS expertise. As a result, the BLS provider contacts an ALS licensed ground ambulance company to provide an ALS paramedic attendant to administer the needed ALS services.
ANGEL VANS
Angel vans are specially equipped vehicles used for transporting neonates. The term "angel van" may actually indicate the use of a ground or air ambulance.
AIR AMBULANCE
Critical care personnel use a helicopter or a fixed wing aircraft for rapid transport of individuals with life-threatening conditions or injuries to the nearest medical/trauma center.
EMERGENCY WATER TRANSPORT
A specially designed marine ambulance that provides emergency water transportation.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2003). Ambulance and medical transport service (10.01.05). Retrieved October 11, 2007 from BlueWeb.
Complete Guide To Medicare Coverage Issues [Computer Software]. (2007, July). Ambulance services (Chapter 10, 4-109 - 4-119). St. Anthony Publishing.
Complete Guide To Medicare Coverage Issues [Computer Software]. (2007, July). Coverage of ambulance services (Section 410.40, 7-37 - 7-39). St. Anthony Publishing.
ORIGINAL EFFECTIVE DATE: 11/1996
MOST RECENT REVIEW DATE: 11/8/2007
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.