“Medical Necessity” for Air Ambulance Services According to Medicare

Medicare demands that certain criteria are met in order to get coverage for the air ambulance services. The information delineated below has been summarized from what has been published by the Department of Health and Human Services – Centers for Medicare and Medicaid Services. The Department has a few basic coverage requirements, perhaps the most important of these is the one that says, “the service is medically reasonable and necessary.” Here, we try to understand this requirement in greater detail.

Air Ambulance Services Transport Requirements

  • The patient’s medical condition demands rapid and immediate air ambulance services.
  • Air ambulance services are required because ALS or BLS can potentially adversely affect the patient’s health or can be a threat to patient’s survival.
  • The POP or point of pickup is inaccessible through ground transport. This can be especially true in areas such as Alaska and Hawaii.
  • The distance to the closest and medically appropriate facility is so much that it demands travel greater than 30 to 60 minutes via ground transport.
  • The instability of ground transport

Medical Conditions that Justify Air Ambulance Services

The list given below is a broad classification and can be further expanded depending on the location and other aspects.

  • Intracranial bleeding (bleeding inside the skull) that warrants the medical intervention of a neurosurgeon.
  • Shock caused by cardiac arrest (cardiogenic shock)
  • Burns that warrant admission of the patient to a burn unit or burn center
  • Medical condition that warrants treatment in a HOU or hyperbaric oxygen unit.
  • Severe and multiple injuries
  • A trauma that can be a threat to patient’s life

Also, facilities such as critical care, burn care, cardiac care and trauma care might not be available at the facility that the patient is first taken, and can be a reason for utilizing air ambulance services.

Understanding these conditions helps people gauge in advance whether Medicare would cover the cost of air ambulance services or not.

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