Medicare covers medically appropriate air ambulance services only if furnished to a beneficiary whose medical condition is such that transportation by either basic or advanced life support ground ambulance is not appropriate.
- The patient's condition at the time of the transport is the determining factor in whether or not the 'medical necessity' standard is met
- Statewide emergency medical services (EMS) systems determine the amount and level of basic and advanced life support land transportation available
- Air ambulance transportation services, either by means of helicopter or fixed wing aircraft, may be covered only when documentation is submitted and indicates both of the following:
- The vehicle and crew requirements are met
- The beneficiary's medical condition required immediate and rapid ambulance transportation that could not have been provided by land ambulance and either:
- The point of pickup is inaccessible by land vehicle (e.g., in remote or sparsely populated areas)
- Great distances or other obstacles (e.g., heavy traffic) are involved in getting the patient to the nearest hospital with appropriate facilities
Medical appropriateness for air ambulance is established only when the beneficiary's condition is such that the time needed to transport by land or the instability of transportation by ground pose a threat to the beneficiary's survival or seriously endanger the beneficiary's health. The following is an advisory list of examples of cases for which air ambulance may be justified. This list is neither all-inclusive nor intended to justify air transportation in all locales, and should be used as a guide.
- Intracranial bleeding potentially requiring neurosurgical intervention
- Cardiogenic shock
- Extensive burns requiring treatment in a burn center
- Conditions requiring treatment in a hyperbaric oxygen unit
- Multiple severe injuries
- Life-threatening trauma