Report ambulance transportation furnished outside the United States only when Medicare coverage requirements are met. Medicare may cover emergency services received at a foreign hospital when the foreign facility is closer to, or more accessible than, the nearest U.S. hospital that is available and equipped to provide the required emergency care.

When billing ambulance transportation originating outside the United States, report loaded mileage only from the U.S. point of entry.

Example: If a beneficiary requires emergency services in Canada and the nearest appropriate hospital is located in Alaska or Washington, begin reporting mileage at the U.S. border crossing point.

Air Ambulance

When transporting a beneficiary from a location outside the United States to a U.S. destination, Medicare calculates payment using the fee schedule associated with the U.S. border port-of-entry ZIP code.

Ground Ambulance

Payment for ground ambulance transportation depends on the pickup and destination locations:

• For transports with both pickup and destination points in Canada or Mexico, Medicare uses the fee schedule associated with the U.S. ZIP code closest to the point of pickup.
• For transports from Canada or Mexico into the United States, Medicare uses the fee schedule associated with the U.S. point-of-entry ZIP code.

Water Ambulance

For transports originating in U.S. territorial waters, Medicare uses the fee schedule associated with the U.S. port-of-entry ZIP code.

At a Glance

Report mileage

• Beginning at the U.S. point of entry for transports originating outside the United States

Air ambulance

• Paid using the U.S. border port-of-entry ZIP code

Ground ambulance

• Canada/Mexico to Canada/Mexico: Closest U.S. ZIP code to the pickup location
• Canada/Mexico to United States: U.S. point-of-entry ZIP code

Water ambulance

• U.S. port-of-entry ZIP code