Does Medicare Part B Cover Ambulance Transportation?

Medicare Part B covers certain ambulance transportation. This article details when and how Medicare Part B covers these services, including conditions, types of transportation, costs, and the appeals process.

Conditions for Coverage

Medicare Part B covers ambulance services only when medically necessary, meaning that other forms of transportation would endanger the patient’s health. The patient’s medical condition at the time of transport dictates whether this standard is met. For instance, an ambulance is generally considered medically necessary for a severe injury or unconsciousness.

Transportation must be to the nearest appropriate medical facility equipped to provide the necessary level and type of care for the patient’s illness or injury. If a closer facility cannot provide the required treatment, Medicare may cover transport to a more distant appropriate facility. Medicare does not cover ambulance transportation for convenience or if other options are simply unavailable.

For emergency situations, Medicare Part B covers ambulance services when a health condition requires immediate medical attention and an ambulance is the quickest and safest means of transport. Non-emergency services may also be covered, but require a doctor’s written order stating medical necessity. For example, bed-confined patients unable to move without assistance may qualify.

Types of Covered Services

Medicare Part B covers both ground and air ambulance services under specific conditions. Ground ambulance services include Basic Life Support (BLS) and Advanced Life Support (ALS) levels, which are covered when medically necessary. This includes transportation from the scene of an accident or from a patient’s home to a hospital, critical access hospital (CAH), or skilled nursing facility (SNF).

Air ambulance transportation is covered only when ground transportation is not medically appropriate. This applies if the patient’s condition requires immediate, rapid transport that ground ambulances cannot provide, or if the pickup location is inaccessible by land. Long distances or heavy traffic that could delay care may also warrant air ambulance coverage.

Medicare’s coverage extends to medically necessary transportation between facilities if the transfer is required for the patient to receive covered care that is not available at the originating facility. Medicare does not cover transport between departments of the same hospital on the same campus. For patients with End-Stage Renal Disease (ESRD), Medicare may cover medically necessary ambulance transportation to and from a dialysis center.

Costs and Your Responsibility

Medicare Part B covers 80% of the Medicare-approved amount for medically necessary ambulance services after the annual Part B deductible is met. The beneficiary is responsible for the remaining 20% coinsurance and any unmet deductible. In 2025, the Part B deductible is $257.

Ambulance companies contracting with Medicare must accept the Medicare-approved amount as full payment. They can only bill the beneficiary for the Part B coinsurance and deductible. If a service is not medically necessary or transport is to a non-covered facility, the beneficiary may be responsible for the full cost.

For non-emergency transport, an ambulance company may issue an Advance Beneficiary Notice of Noncoverage (ABN) if they believe Medicare may not cover a service. Signing an ABN indicates the beneficiary understands Medicare may deny payment and agrees to be financially responsible. If Medicare denies payment and an ABN was not issued when required, the beneficiary might be protected from financial liability.

Appealing a Denied Claim

If Medicare Part B denies an ambulance claim, beneficiaries have the right to appeal. The Medicare Summary Notice (MSN) provides initial denial information, explaining the reason and outlining appeal steps.

The Medicare appeals process involves several levels. The first is a Redetermination, which must be requested within 120 days of receiving the initial denial. If unfavorable, the next step is a Reconsideration by a Qualified Independent Contractor (QIC).

Further appeals can proceed to a hearing before an Administrative Law Judge if the amount in controversy meets a certain threshold, which is $190 in 2025. The process can escalate to the Medicare Appeals Council and judicial review. Beneficiaries can submit additional documentation or a physician’s letter to support their claim.