US · guidance
CMS Pub. 100-04, ch. 15, § 30.1.4
CWF Editing of Ambulance Claims for Inpatients
Hospital bundling rules exclude payment to independent suppliers of ambulance services for
beneficiaries in a hospital inpatient stay (see IOM Pub. 100-04, Medicare Claims Processing,
chapter 3 - Inpatient Hospital Billing, Section 10.4 - Payment of Nonphysician Services for
Inpatients). CWF performs reject edits to incoming claims from suppliers of ambulance
services.
Upon receipt of a hospital inpatient claim at the CWF, CWF searches paid claim history and
compares the period between the hospital inpatient admission and discharge dates to the line item
service date on an ambulance claim billed by a supplier. The CWF will generate an unsolicited
response when the line item service date falls within the admission and discharge dates of the
hospital inpatient claim.
Upon receipt of an unsolicited response, the A/B MAC (B) will adjust the ambulance claim and
recoup the payment.
Ambulance services with a date of service that are the same as an admission or discharge date on
an inpatient claim are separately payable and not subject to the bundling rules.
History
(Rev. 1696; Issued: 03-06-09; Effective/Implementation Date: 04-06-09)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
48b4ba92c602fb499f9f1f4e3087f72ab4653ab558ce894459dfb9d9ba2dfbe7
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