Air Ambulance Payment Policy When Beneficiary Pronounced Dead
Background
Medicare has a longstanding policy to allow partial payment for an ambulance service where the ambulance begins its trip to pick up the beneficiary, but the beneficiary is pronounced dead before the pickup can be made. This policy did not explicitly state the air ambulance service was included in this policy. The implementation of an ambulance fee schedule contains a provision authorizing partial payment for an air ambulance service when an air ambulance takes off to pick up a beneficiary, but the beneficiary is pronounced dead before the pickup can be made. The following clarifies how this policy will be implemented under the fee schedule.
Medicare Policy
Medicare allows payment for an air ambulance service when the air ambulance takes off to pick up a Medicare beneficiary, but the beneficiary is pronounced dead before being loaded onto the ambulance for transport (either before or after the ambulance arrives on the scene). Payment is conditional on the air ambulance service having been otherwise medically necessary. In such a circumstance, the allowed amount is the appropriate air base rate, i.e., fixed wing or rotary wing. However, no amount shall be allowed for mileage or for a rural adjustment that would have been allowed had the transport of a living beneficiary or of a beneficiary not yet pronounced dead been completed.
For the purpose of this policy, a pronouncement of death is effective only when made by an individual authorized under State law to make such pronouncements.
This policy also states no amount shall be allowed if the dispatcher received pronouncement of death and had a reasonable opportunity to notify the pilot to abort the flight. Further, no amount shall be allowed if the aircraft has merely taxied but not taken off or, at a controlled airport, has been cleared to take off but not actually taken off.
Supplier Billing Requirements
Suppliers must use the modifier QL (Patient pronounced dead after ambulance called) to indicate the circumstance when an air ambulance takes off to pick up a beneficiary but the beneficiary is pronounced dead before the pickup can be made.
The supplier must submit documentation with the claim sufficient to show that:
- The air ambulance was dispatched to pick up a Medicare beneficiary;
- The aircraft actually took off to make the pickup;
- The beneficiary to whom the dispatch relates was pronounced dead before being loaded onto the ambulance for transport;
- The pronouncement of death was made by an individual authorized by State law to make such pronouncements; and
- The dispatcher did not receive notice of such pronouncement in sufficient time to permit the flight to be aborted before take off.
The appropriate air base
rate (fixed wing or rotary wing, as applicable) will be allowed
for a claim for an air ambulance service that meets the requirements
of this instruction. No mileage or rural adjustment will be made.
During the fee schedule transition, an amount based on a blended
rate will be allowed. The applicable service codes follow.
A0430
Ambulance
service, conventional air services, transport, one way (fixed
wing)
(Short Description = Fixed wing air transport)
A0431
Ambulance
service, conventional air services, transport, one way (rotary
wing);
(Short Description = Rotary wing air transport)
Page Last Updated: Tuesday, 04-Dec-2007 13:19:31 CST
