CMS Pub. 100-04, ch. 32, § 350.6

Payment is made for necessary physician and ambulance services that meet the other coverage requirements of the

Medicare program, and are furnished in connection with a covered foreign hospitalization.

A. Coverage of Physician and Ambulance Services Furnished Outside the U.S.

Where inpatient services in a foreign hospital are covered, payment may also be made for:

Physicians’ services furnished to the beneficiary while he/she is an inpatient,

Physicians’ services furnished to the beneficiary outside the hospital on the day of his/her admission as an

inpatient, provided the services were for the same condition for which the beneficiary was hospitalized (including

the services of a physician who furnishes emergency services in Canadian waters on the day the patient is

admitted to a Canadian hospital for a covered emergency stay) and,

Ambulance services, where necessary, for the trip to the hospital in conjunction with the beneficiary’s admission

as an inpatient. Return trips from a foreign hospital are not covered.

In cases involving foreign ambulance services, the general requirements in chapter 15 are also applicable, subject to the

following special rules:

If the foreign hospitalization was determined to be covered on the basis of emergency services, the medical

necessity requirements outlined in chapter 15 are considered met.

The definition of “physician,” for purposes of coverage of services furnished outside the U.S., is expanded to

include a foreign practitioner, provided the practitioner is legally licensed to practice in the country in which the

services are furnished.

Only the beneficiary may file for Part B benefits. The assignment method may not be used. However, where the

beneficiary is deceased, the rule for settling Part B underpayments is applicable, i.e., payment may be made to

the foreign physician or ambulance company on the basis of an unpaid bill, provided the physician or ambulance

company accepts the MACs reasonable charge determination as the full charge.

The regular deductible and coinsurance requirements apply to physician and ambulance services.