Origin and Destination are Ambulance Providers

If both the origin and destination of ambulance transports are providers, the below three criteria identifies which provider will bill for the transport.

National Provider Identifiers (NPIs)

  • If NPIs of the two providers are different
    • Ambulance service is separately billable
  • If NPIs of both providers are same
    • See Campus below

Campus

"Campus is the physical area immediately adjacent to the provider's main buildings, other areas, and structures not strictly contiguous to the main buildings but are located within 250 yards of the main buildings and any of the other areas the Centers for Medicare & Medicaid Services Regional Office determines are part of the provider's campus."

  • If the campuses of the two providers who share same NPI are the same
    • Transport is not separately billable; and
    • Provider is responsible for payment
  • If the campuses of the two providers are different
    • See Beneficiary Status – Inpatient vs. Outpatient below

Beneficiary Status – Inpatient vs. Outpatient

  • If he/she is an inpatient at both providers (i.e., inpatient status at both origin and destination, and providers share same NPI but are located on different campuses),
    • Transport is not separately billable;
    • Provider is responsible for payment; and
    • All other combinations (i.e., outpatient-to-inpatient, inpatient-to-outpatient, and outpatient-to-outpatient) are separately billable
  • If point of origin is not a provider
    • Transport is not covered under Part A because beneficiary is not an inpatient of any Part A provider at time of transport; and
    • Ambulance services are excluded from the 3-day preadmission payment window
       

Last Updated Fri, 25 Aug 2017 15:17:44 +0000