CMS Pub. 100-04, ch. 19, § 100.12.2

Payment Policy

(Rev. 2102, Issued: 11-19-10, Effective: 04-01-11, Implementation: 04-04-11)

For dates of service on or after December 21, 2000 and prior to January 1, 2004,

medically necessary ambulance services provided by an IHS CAH or an entity that is

owned and operated by the IHS CAH are paid based on 100 percent of the reasonable

cost if the 35 mile rule for cost-based payment is met. In order for the 35 mile rule to be

met, the IHS CAH or the entity that is owned and operated by the IHS CAH, must be the

only provider or supplier of ambulance services that is located within a 35 mile drive of

the IHS CAH or the entity. Those CAHs that meet the 35 mile rule for cost-based

payment shall report condition code B2 (CAH ambulance attestation) on their bills.

For dates of service on or after January 1, 2004, ambulance services furnished by an IHS

CAH or by an entity that is owned and operated by the IHS CAH are paid based on 101

percent of reasonable cost if the 35 mile rule for cost-based payment is met.

When the 35 mile rule for cost-based payment is not met, the ambulance services

furnished by the IHS CAH or by the entity that is owned and operated by the IHS CAH

are paid based on the ambulance fee schedule.

The IHS CAHs shall notify the A/B MAC (A) whether the ambulance service meets or

does not meet the 35 mile ambulance rule.

The Medicare Part B deductible and coinsurance apply to ambulance services, but are

waived by the IHS.

See Chapter 15, §30.2.3 of Pub. 100-04, Medicare Claims Processing Manual, for more

information on the payment of ambulance claims.