US · guidance
CMS Pub. 100-04, ch. 19, § 100.12.2.1
A/B MAC (A) - CAH Ambulance Services - Medicare Part
B -Claims Processing
(Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06)
Medically necessary ambulance services originating out of an IHS CAH with a hospital-based ambulance service are submitted with revenue code 054X (ambulance) with
charges for ambulance, as well as the appropriate ambulance HCPCS codes on TOB 85X.
IHS CAHs that meet the 35 mile rule for cost based payment shall report condition code
B2 (CAH ambulance attestation) on their bills to the A/B MAC (A).
If an outpatient encounter occurs at the same time a covered ambulance service is
provided, the IHS CAH may bill for a clinic visit (revenue code 051X) as well as the
ambulance charges (revenue code 054X) and will be paid separately for each service.
The MSN is suppressed.
History
(Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
764eb2d70e0d75a6781b9f8f40b488066422e5b22e4c2939d34a04c4fbc87ee4
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.