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CodeMap® LCD-L35162


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LCD for Ambulance Services (Ground Ambulance) (L35162)
See related Articles:
A54574-Billing and Coding: Ambulance Services (Ground Ambulance)

Contractor Information

Contractor Name: Novitas Solutions, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 04412

Contractor Type: MAC B

LCD Information

LCD ID Number: L35162 Status: A-Approved

LCD Title: Ambulance Services (Ground Ambulance)

Geographic Jurisdiction: Texas Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 01/01/2020

Revision End Date:

CMS National Coverage Policy:

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for ground ambulance services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for ground ambulance services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:

IOM Citations:

  • CMS IOM Publication 100-02, Medicare Benefit Policy Manual, 
    • Chapter 10, Section 10.2.3 Medicare Policy Concerning Bed-Confinement, Section 10.2.6 Effect of Beneficiary Death on Medicare Payment for Ground Ambulance Transports, Section 10.3 The Destination, Section 10.3.3 Separately Payable Ambulance Transport Under Part B versus Patient Transportation that is Covered Under a Packaged Institutional Service, Section 10.3.6 Appropriate Facilities
  • CMS IOM Publication 100-04, Medicare Claims Processing Manual,
    • Chapter 6, Section 20.3.1 Other Services Excluded from SNF PPS and Consolidated Billing Ambulance Services
    • Chapter 15, Section 10.4 Additional Introductory Guidelines, Section 30.2(D) Revenue Code/HCPCS Reporting
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 3, Section Signature Requirements
    • Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1861(s)(7), Ambulance Services.
  • Title XVIII of the Social Security Act, Section 1861(v)(1)(K)(ii), Bona Fide Emergency Services.
  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medical payment may be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Code of Federal Register (CFR) References:

  • CFR, Title 42, Volume 2, Chapter IV, Subchapter B, Part 410, Subpart B, Section 410.40 - Coverage of ambulance services.
  • CFR, Title 42, Volume 2, Chapter IV, Subchapter B, Part 410, Subpart B, Section 410.41- Requirements for ambulance suppliers.
  • CFR, Title 42, Volume 3, Chapter IV, Subchapter B, Part 414, Subpart H, Section 414.605 - Definitions.
  • CFR, Title 42, Volume 3, Chapter IV, Subchapter B, Part 424, Subpart C, Section 424.36 - Signature requirements.
  • CFR, Title 42, Volume 3, Chapter IV, Subchapter B, Part 424, Subpart C, Section 424.40 - Request for payment effective for more than one claim.

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02/08/2023 08:12:02

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