CMS Pub. 100-04, ch. 15, § 20.1.1

Payment under the fee schedule for ambulance services:

• Includes a base rate payment plus a separate payment for mileage;

• Covers both the transport of the beneficiary to the nearest appropriate facility and all

items and services associated with such transport; and

• Does not include a separate payment for items and services furnished under the

ambulance benefit.

Payment for items and services is included in the fee schedule payment. Such items and services

include but are not limited to oxygen, drugs, extra attendants, and EKG testing (e.g., ancillary

services) - but only when such items and services are both medically necessary and covered by

Medicare under the ambulance benefit.

For additional information on the fee schedule, contractors may refer to the “Ambulance

Services Center” on the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AmbulanceFeeSchedule/index.html