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Printed Date: 9/22/2015
Since implementation, the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport has instructed the Medicare Administrative Contractors (MACs) to allow up to 80 one-way trips in a 60-day period per prior authorization request. Situations requiring more than 80 one-way trips in a 60-day period require a separate prior authorization request.
Palmetto GBA conducted several Organizational Process Improvement Coaching Projects (OPICPs) throughout the state of South Carolina with ambulance suppliers of these transports and continues to work with the Centers for Medicare & Medicaid Services (CMS) on reducing provider burden for patients with chronic conditions.
Effective June 3, 2019, MACs may allow up to 240 one-way trips in a 180 day period per prior authorization request for beneficiaries with chronic conditions that are deemed not likely to change over time that also meet all Medicare requirements for repetitive non-emergent ambulance transport. The medical records must clearly indicate the condition is chronic. In addition, two previous prior authorizations requests must have established that the beneficiary’s medical condition has not changed or has deteriorated.
The MACs shall continue to allow up to 80 one-way trips in a 60-day period per prior authorization request for beneficiaries with acute conditions meeting all Medicare requirements for repetitive non-emergent ambulance transport.
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Last Updated: 08/28/2019