2006 Ambulance Fee Schedule Transition
The Centers for Medicare & Medicaid Services (CMS) phased in the implementation of the Ambulance Fee Schedule over a five year period which began on April 1, 2002. Beginning January 1, 2006, and each year thereafter, the full fee schedule comprises the entire Medicare allowed amount and no portion of the provider's reasonable cost or the supplier's reasonable charge shall be considered. Section 4531 (b) (2) of the Balanced Budget Act (BBA) of 1997 added a new section 1834 (l) to the Social Security Act, which mandates implementation of the national fee schedule for ambulances services furnished as a benefit under Medicare Part B. The Ambulance Fee Schedule applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers i.e., hospitals, critical access hospitals and skilled nursing facilities. Section 1834 (l) also requires mandatory assignment for ambulance services. Ambulance providers and suppliers must accept the Medicare allowed charge as payment in full and not bill or collect from the beneficiary any amount other than any unmet Part B deductible and the Part B coinsurance amounts.
As of January 1, 2006, payment under the fee schedule for ambulance services:
- Includes a base rate payment plus a separate charge for mileage;
- Covers both the transport of the beneficiary to the nearest appropriate facility and all items and services associated with such transport; and
- Precludes a separate payment for items and services furnished under the ambulance benefit.
During the transition period, the Centers for Medicare and Medicaid Services (CMS) allowed ambulance suppliers that were previously permitted to bill separately for medically necessary supplies and ancillary services furnished incident to the ambulance transport to continue to do so until the full implementation of the Ambulance Fee Schedule. Such items and services included, but were not limited to drugs, supplies, waiting time, extra attendants, EKG testing, and ambulance differential charges - but only when such items and services were both medically necessary and covered by Medicare under the ambulance benefit.
The Centers for Medicare and Medicaid Services (CMS) established two new temporary codes for ambulance services, for use during the transition period only, to allow the Basic Life Support level of payment when an Advance Life Support (ALS) vehicle was used for an emergency or non-emergency transport, but no ALS level service was furnished. Beginning January 1, 2006, Medicare will not permit reimbursement of Q3019 and Q3020 as the transition to the Ambulance Fee schedule is complete.
As of January 1, 2006, Wisconsin Physician Service, as the Medicare Part B carrier will no longer reimburse the following:
- Disposable supplies,
- Oxygen,
- Drugs,
- Extra attendants,
- Ambulance waiting time,
- EKG testing,
- Q3019, (Vehicle used, emergency transport, no ALS service furnished); and
- Q3020, (ALS vehicle used, non-emergency transport, no ALS service furnished)
Generally, a claim for an ambulance service will require two entries, e.g., one Health Care Procedure Coding System (HCPCS) code for the service and one HCPCS code for mileage. Suppliers who do not bill mileage would have one entry only for the service.
Please refer to the updated AMB-001, Ambulance Services National Coverage Provision (NCP). It is located on the Wisconsin Physicians Service (WPS) Website. Once on the WPS policy page, please scroll down to your applicable state. The WPS Website is available by clicking here.
