US · guidance
CMS Pub. 100-02, ch. 10, § 10.2.1
Necessity for the Service
B3-2120.2.A, A3-3114.B, HO-236.2
Medical necessity is established when the patient's condition is such that use of any other
method of transportation is contraindicated. In any case in which some means of
transportation other than an ambulance could be used without endangering the
individual's health, whether or not such other transportation is actually available, no
payment may be made for ambulance services. In all cases, the appropriate
documentation must be kept on file and, upon request, presented to the A/B MAC (A) or
(B). It is important to note that the presence (or absence) of a physician’s order for a
transport by ambulance does not necessarily prove (or disprove) whether the transport
was medically necessary. The ambulance service must meet all program coverage
criteria in order for payment to be made.
In addition, the reason for the ambulance transport must be medically necessary. That is,
the transport must be to obtain a Medicare covered service, or to return from such a
service.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2abb3c9bd5c86b40ef3f7375545cd0c4e746992cf9ecd640593521f1ba74c17b
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