CMS Pub. 100-02, ch. 10, § 10.4.9

Ambulance Transports

(Rev. 103; Issued: 02-20-09; Effective Date: 01-05-09; Implementation Date: 03- 20-09)

Because the Medicare ambulance benefit is a transport benefit, if no transport of a

Medicare beneficiary occurs, then there is no Medicare-covered service. In general, if the

beneficiary dies before being transported, then no Medicare payment may be made.

Thus, in a situation where the beneficiary dies, whether any payment under the Medicare

ambulance benefit may be made depends on the time at which the beneficiary is

pronounced dead by an individual authorized by the State to make such pronouncements.

The chart below shows the Medicare payment determination for various air ambulance

scenarios in which the beneficiary dies. In each case, the assumption is that the

ambulance transport would have otherwise been medically necessary. If the flight is

aborted for other reasons, such as bad weather, the Medicare payment determination is

based on whether the beneficiary was onboard the air ambulance.

Air Ambulance Scenarios: Beneficiary Death

Time of Death Pronouncement Medicare Payment

Determination

Prior to takeoff to point-of-pickup

with notice to dispatcher and time to

abort the flight.

None.

NOTE: This scenario includes

situations in which the air

ambulance has taxied to the

runway, and/or has been cleared for

takeoff, but has not actually taken

off.)

After takeoff to point-of-pickup, but

before the beneficiary is loaded.

Appropriate air base rate with no

mileage or rural adjustment; use the

QL modifier when submitting the

claim.

After the beneficiary is loaded

onboard, but prior to or upon arrival

at the receiving facility.

As if the beneficiary had not died.