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Ambulance Billing Guide
- Ambulance Billing Guidance
- Ambulance Duplicate Claim Denials
- Ambulance Services and the Advance Beneficiary Notice of Noncoverage
- Ambulance Transports Included in SNF Consolidated Billing
- Ambulance Physician Certification Statement Guidelines
- Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport
- New York State Ambulance Services in Rural Areas (for JK providers only)
- Coverage of Rural Air Ambulance Services
- National AB Medicare Administrative Contractor Ambulance Provider/Supplier Coalition
- Hospital-Based Ambulance Basic Billing Guidelines
- Ambulance Transports Excluded from SNF Consolidated Billing
- Ambulance Medical Necessity Reminder for ESRD Patients
- National A/B Medicare Administrative Contractor Ambulance Provider/Supplier Coalition
- Related Content
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Related Articles
- Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10
- Ambulance Medical Necessity
- Ambulance Rural ZIP Code Search
- Billing for A0426 or A0428
- Medical Necessity of Ambulance Services
- Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports
- Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity
Ambulance Services and the Advance Beneficiary Notice of Noncoverage
To follow are Medicare’s guidelines regarding the use of an ABN for ambulance services.
Emergency or Urgent Situations
In general, a notifier may not issue an ABN to a beneficiary who has a medical emergency or is under similar duress. Forcing delivery of an ABN during an emergency may be considered coercive. ABN usage in the ER may be appropriate in some cases where the beneficiary is medically stable with no emergent health issues.
Nonemergent/Urgent Ambulance Transport
If the provider or supplier wants to transfer liability to the beneficiary, issuance of the ABN is mandatory for ambulance transport services if all the following three criteria are met:
- The service being provided is a Medicare covered ambulance benefit under Section 1861(s)(7) of the SSA and regulations under this section as stipulated in 42 CFR Section 410.40-.41;
- The healthcare provider or supplier believes that the service may be denied, in part or in full, as “not reasonable and necessary” under Section 1862(a)(1)(A) for the beneficiary on that particular occasion; and
- The ambulance service is being provided in a nonemergency situation. (The patient is not under duress.)
ABN issuance is mandatory only when a beneficiary’s covered ambulance transport is modified to a level that is not medically reasonable and necessary and will incur additional costs. If an ambulance transport is statutorily excluded from coverage because it fails to meet Medicare’s definition of the ambulance benefit, a voluntary ABN may be issued to notify the beneficiary of his/her financial liability as a courtesy.
Posted 3/27/2025