What is Medical Necessity?
 

Each carrier makes its own determination of medical necessity.  Many, but not all, follow the Medicare guidelines set by CMS (Center for Medicare & Medicaid Services) which is as follows:

Patient is bed confined
Patient is unable to walk
Patient is unable to sit in a chair or wheelchair for the duration of transport

Generally, to be covered, ambulance service must be medically necessary and reasonable.  Medical necessity is established when the patient's clinical condition and ambulatory status are such that use of any other method of transportation is contraindicated.  In any case in which some means of transportation other than an ambulance could be utilized without endangering the individual's health, whether or not such other transportation is actually available, no payment may be made for ambulance service.

In all cases, it is important to document the reason why ambulance transport was the preferred method due to the patient's condition (not patient choice). 

Your physician or other health care provider may be asked to write a letter confirming the reason for the ambulance transport in support of our claim.