General Medicare Transport Guidelines

Ambulance service is covered when:

• It is medically necessary because the patient is suffering from an illness or injury, which will not allow transport by any other means.
• Transport is to the nearest appropriate medical facility from the point of pick-up of the patient.

Transportation points :

• Point of pick up: Medical facility, hospital, residence, nursing home, SNF, long term acute care facility, hospice, rehabilitation facility, detoxification center, mental health facility, street, public buildings, etc.
• Destination: Medical facility, hospital, residence, nursing home, SNF, long term acute care facility, hospice, rehabilitation facility, detoxification center, mental health facility, street, public building, etc.

Ambulance transports from one hospital to another

Interhospital transfer refers to the patient's discharge from one hospital inpatient stay or ER for admission to a second hospital. This is a covered service when the following criteria are met:

• The services needed by the patient are not available at the first hospital. For example:
• The specialty skills of the physician are not available, or
• The tests which are required are not available (such as special x-rays, CT, MRI, Angiogram, Bone Scan, V/Q Scan).
  
• The patient's condition is so severe, treatment is needed enroute, or it is unsafe for the patient to travel by any other means without trained medical personnel during the time of moving between the two hospitals.
• Some conditions which may be present and indicate an ambulance is necessary include: 1. abnormal vitals signs from what is considered normal for that patient 2. use of medications by IV enroute; 3. the need for a nurse during transport; 4. the need for cardiac monitor or oxygen which was used previously in the hospital.

• An interhospital transfer is NOT a covered service when the expertise and tests necessary are available at the facility, but it is a matter of patient, family, or physician preference to use another facility.

Special interhospital transfers that may be covered:

• From a detoxification unit to an acute hospital
• Emergency room to a mental health or psychiatric facility

If you have any additional questions about your ambulance transport by Erickson Ambulance being covered by Medicare, please feel free to contact Erickson Ambulance at telephone number: 262-632-5412