US · guidance
CMS Pub. 100-08, ch. 6, § 6.4.4
Reasonable and Necessary Services
When data analysis indicates, fiscal intermediaries, carriers, or MACs may perform
medical review of rural air ambulance claims in those instances noted in the above
paragraph where there is financial or employment relationship between the person
requesting an air ambulance transport and the person providing the service. The fiscal
intermediaries, carriers, or MACs may also conduct medical review of rural air
ambulance claims with “deemed” medical necessity status when there are questions as to
whether the transport was made pursuant to a protocol which has been approved by the
Secretary; or questions as to whether the transport was inconsistent with an approved
protocol. Medicare payment can be made only to the closest facility capable of providing
the care needed by the beneficiary irrespective of whom orders the transport.
History
(Rev. 308, Issued: 10-30-09, Effective: 11-30-09, Implementation: 11-30-09)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
581866efbe53d4cca36d6f6b5d70b207b96cbfec2cadef80d39dd3951d2b0382
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