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CodeMap® LCD-L34549


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LCD for Ambulance Services (L34549)
See related Articles:
A56468-Billing and Coding: Ambulance Services

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 11201

Contractor Type: MAC A

LCD Information

LCD ID Number: L34549 Status: A-Approved

LCD Title: Ambulance Services

Geographic Jurisdiction: South Carolina Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 07/29/2021

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member

Title XVIII of the Social Security Act §1861(s)(7) defines ambulance service where the use of other methods of transportation is contraindicated by the individual's condition, but only to the extent provided in regulations

Title XVIII of the Social Security Act §1861(v)(1)(K)(ii) defines emergency services

42 CFR §410.40 addresses the coverage of ambulance services

42 CFR §424.36 (a)-(e) addresses signature requirements

Federal Register, Vol. 66, No. 233, December 4, 2001, Rules and Regulations, pp.62980, Ambulance Restocking and the Anti-Kickback Statute

Federal Register, Vol. 67, No. 39, February 27, 2002, Rules and Regulations, pp. 9102, 9106, and 9108

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 10, §10.1 Vehicle and Crew Requirement, §10.1.1 The Vehicle, §10.1.2 Vehicle Requirements for Basic Life Support and Advanced Life Support, §10.1.3 Verification of Compliance, §10.1.4 Ambulance Services Furnished by Providers of Services, §10.1.5 Equipment and Supplies, §10.2 Necessity and Reasonableness, §10.2.1 Necessity for the Service, §10.2.3 Medicare Policy Concerning Bed-Confinement, §10.2.4 Documentation Requirements, §10.2.5 Transport of Persons Other Than the Beneficiary, §10.3.5 Locality, §10.3.6 Appropriate Facilities, §10.4.2 Medical Reasonableness, §10.4.3 Time Needed for Ground Transport. §10.4.7 Documentation, §20.1 Mandatory Assignment Requirements, §20.1.1 Managed Care Providers/Suppliers, §20.1.2 Beneficiary Signature Requirements, §30 Implementation of the Ambulance Fee Schedule, §30.1 Definition of Ambulance Services, §30.1.1 Ground Ambulance Services, and §30.1.2 Air Ambulance Services

CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 15, §10 Overview, §10.1 Authorities, §10.1.1 Statutes and Regulations, §10.1.2 Other References to Ambulance Related Policies in the CMS Internet Only Manuals, §10.3 Definitions, §20.1.2 Jurisdiction, §20.1.5 ZIP Code Determines Fee Schedule Amounts, § CMS Supplied National ZIP Code File and National Ambulance Fee Schedule File, §20.1.6 Contractor Determination of Fee Schedule Amounts, §20.2 Payment for Mileage Charges, §20.4 Ambulance Inflation Factor (AIF), §20.5 Documentation Requirements, §30.1.4 CWF Editing of Ambulance Claims for Inpatients, and §40 Medical Conditions List and Instructions

CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 6, §6.4 Medical Review of Rural Air Ambulance Services, §6.4.1 "Reasonable" Requests, §6.4.2 Emergency Medical Services (EMS) Protocols, §6.4.3 Prohibited Air Ambulance Relationships, §6.4.4 Reasonable and Necessary Services, and §6.4.5 Definition of Rural Air Ambulance Services

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12/01/2022 02:10:54

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