What services does Medicare usually cover?

he following list some of the more common situations, which suggest transportation by ambulance may be medically indicated:

  • The patient was transported in an emergency situation (e.g. as a result of an accident, injury or acute illness)
  • Emergency measures or treatment were required (e.g. drugs, CPR, cardiac monitor, etc.)
  • The patient needed to be restrained to prevent injury to himself or others (e.g. patient was combative, patient was convulsive, etc.
  • The patient was unconscious (was unable to respond to external stimuli), this does not include patients who are comatose or in a vegetative state, with no specific reason for transport
  • The patient was in shock
  • The patient required IV fluids to maintain adequate blood pressure (e.g. dehydration, bleeding, cardiac arrhythmias, etc.) or an access line to administer medication(s)
  • The patient required oxygen in route to his destination. However, this is not a covered condition if oxygen equipment has been prescribed as part of therapy or a treatment regimen and that equipment was available to the patient
  • The patient required immobilization to prevent further injury of a fracture or possible fracture
  • The patient sustained an acute stroke or myocardial infarction (this does not include patients who have a history of a stroke or myocardial infarction and are able to be transported by other means because no acute medical condition exists)
  • The patient was experiencing symptoms indicative of a possible myocardial infarction or stroke
  • The patient was experiencing a severe hemorrhage
  • The patient was bed confined before and after the ambulance trip (bed confined due to old age does not qualify). Document the patient’s condition in your files to include the reason why the patient was bed confined
  • The patient could be moved only by stretcher and any other method of transportation would result in injury or would be detrimental to the patient’s health

This is not an all-inclusive list of covered conditions. If the patient is transported for any non-emergency condition, the medical need for the services must be clearly documented.