A/B MAC - CAH Ambulance Services - Medicare Part B - Payment Policy for Indian Health Services (Rev. 2102, 04-04-11)

by  Jared Staheli
June 25th, 2015

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 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.

References:

A/B MAC - CAH Ambulance Services - Medicare Part B - Payment Policy for Indian Health Services (Rev. 2102, 04-04-11). (2015, June 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/a-b-mac-cah-ambulance-services-medicare-part-b-payment-policy-for-indian-health-services-rev-2102-04-04-11-26870.html

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