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Coverage of Rural Air Ambulance Services

Section 415 of the Medicare Modernization Act of 2003 provides coverage for rural air ambulance services that are reasonable and necessary and ordered by qualified personnel.

Medicare considers the following personnel qualified to order air ambulance services:

  • Physician
  • Registered nurse practitioner (from the transferring hospital)
  • Physician assistant (from the transferring hospital)
  • Paramedic or EMT (at the scene), and
  • Trained first responder (at the scene)

The reasonable and necessary requirement for rural air ambulance transport may be "deemed" to be met when the service is provided pursuant to an established state or regional EMS agency protocol. The Secretary of the Department of Health and Human Services, which administers Medicare through the CMS, has delegated responsibility for approval of the protocols to local MACs.

CMS defines "established" to mean those protocols that have been reviewed and approved by the state EMS agencies or have been developed according to state EMS umbrella guidelines. Submission of protocols for review and subsequent approval by the MAC will "deem" that the reasonable and necessary requirement for rural air ambulance transport has been met by the provider.

Providers that anticipate rural air ambulance transports pursuant to such a protocol may submit their written protocol to their MAC for review and approval in advance.

Providers may submit protocols for review as follows:

J6 Providers:

National Government Services, Inc.
Attn: Air Ambulance Protocol Approval Request
P.O. Box 7108
Indianapolis, IN 46207-7108

JK Providers:

National Government Services, Inc.
Attn: Air Ambulance Protocol Approval Request
P.O. Box 6474
Indianapolis, IN 46206-6474

Providers will be notified of all protocol review decisions in writing within 30 days of receipt by National Government Services, Inc. Please include a contact name, telephone number and address with your submissions. Review decisions will be mailed to this address.

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