Medicaid Benefits: Ambulance Services
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 46 No - 0 NR - 5 | 2018 data limited to CN | Yes - 6 | Yes - 10 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes | CN | No | One round trip per date of service | - | - |
| Alaska | Yes | CN | No | No | - | - |
| Arizona | Yes | CN | No | To and from the nearest appropriate medical facility | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | No | No | - | - |
| Colorado | Yes | CN | No | No | - | - |
| Connecticut | Yes | CN | No | No | - | - |
| Delaware | Yes | CN | No | Emergency services, medically necessary | - | - |
| District of Columbia | Yes | CN | No | Some services may require a single case agreement. | - | - |
| Florida | Yes | CN | No | No | - | - |
| Georgia | Yes | CN | No | No | - | - |
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | No | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $3.00 per trip | No | - | - |
| Kentucky | Yes | CN | No | No | - | - |
| Louisiana | Yes | CN | No | NR | - | - |
| Maine | Yes | CN | $.50 to $2/day depending on payment amount, up to $20/month | No | - | - |
| Maryland | Yes | CN | No | No | - | - |
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | No | No | - | - |
| Minnesota | Yes | CN | No | No | - | - |
| Mississippi | Yes | CN | $3 per trip | NR | - | - |
| Missouri | Yes | CN | MO HealthNet is required to pay for all Medicare cost-sharing (coinsurance and deductibles) for QMB-eligible participants. | No | - | - |
| Montana | Yes | CN | No | All Ambulance services are reviewed for medical necessity. | - | - |
| Nebraska | Yes | CN | No | No | - | - |
| Nevada | Yes | CN | No | No | - | - |
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | No | Air transport authorization for MN | - | - |
| New Mexico | Yes | CN | No | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | Emergency only | PA for OOS services | - | - |
| North Dakota | Yes | CN | No | No | - | - |
| Ohio | Yes | CN | No | No | - | - |
| Oklahoma | Yes | CN | No | NR | - | - |
| Oregon | Yes | CN | No | No | - | - |
| Pennsylvania | Yes | CN | No | No | - | - |
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | No | NR | - | - |
| Tennessee | Yes | CN | No | No | - | - |
| Texas | Yes | CN | No | Non-emergency ambulance transports require prior authorization | - | - |
| Utah | Yes | CN | No | No | - | - |
| Vermont | Yes | CN | No | No | - | - |
| Virginia | Yes | CN | No | NR | - | - |
| Washington | Yes | CN | No | Some require prior authorization | - | - |
| West Virginia | Yes | CN | No | No | - | - |
| Wisconsin | Yes | CN | Non-emergency ambulance services require a $2 copayment. No copayment for emergency ambulance services | Non-emergency transportation by air or water requires prior prior authorization | - | - |
| Wyoming | Yes | CN | No | No | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 8 No - 48 | ||||
| Alabama | Yes | CN | No | Transports by air | Fee for service | |
| Alaska | Yes | CN | No | Fee for service, using Medicare upper limits | ||
| American Samoa | Yes | See territory-specific FN | No | On-island emergency services provided by Government Emergency Medical Services. Transportation to and from off-island services coordinated through Medicaid agency | Dependent upon source of transportation | |
| Arizona | Yes | CN & MN | No | Fee for service | ||
| Arkansas | Yes | CN & MN | No | Fee for service | ||
| California | Yes | CN & MN | No | Fee for service | ||
| Colorado | Yes | CN | No | Fee for service | ||
| Connecticut | Yes | CN & MN | No | Fee for service | ||
| Delaware | Yes | CN | No | Fee for service, additional payment for more than 10 miles | ||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | $1/non-emergency trip | Non-emergency transports | Fee for service for emergency transports, fixed fee to sole source vendor for non-emergency transports | |
| Georgia | Yes | CN & MN | No | 2 trips/day | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Guam | Yes | CN | No | Fee for service using Medicare fee schedule | ||
| Hawaii | Yes | CN & MN | No | Fee for service | ||
| Idaho | Yes | CN | $3/trip if determined an inappropriate use, except for tribal members and pregnant women | Non-emergency transports | Fee for service | |
| Illinois | Yes | CN & MN | No | Non-emergency transports by ambulance | Fee for service | |
| Indiana | Yes | CN | $.50-$2/non-emergency transport, depending on payment | Non-emergency transports beyond 20 one-way trips/year, non-emergency transports greater than 50 miles | Fee for service | |
| Iowa | Yes | CN & MN | $2/day for non-emergency transports | Fee for service | ||
| Kansas | Yes | CN & MN | $3/date of service for non-emergency trip | Reasonable charge with limits | ||
| Kentucky | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Louisiana | Yes | CN & MN | No | Non-emergency transports | Fee for service, using Medicare payment ceilings | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Non-emergency air and out-of-state transports | Fee for service | |
| Maryland | Yes | CN & MN | No | Fee for service | ||
| Massachusetts | Yes | CN & MN | No | Fee for service | ||
| Michigan | Yes | CN & MN | No | Fixed wing transports and non-borderland out-of-state transports | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | No | Fee for service using Medicare unadjusted base rate | ||
| Mississippi | Yes | CN | $3/trip | Urgent fixed wing air ambulance transports | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | No | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | No | All transports must meet specified medical necessity criteria | Non-emergency transports | Fee for service |
| Nebraska | Yes | CN & MN | No | Fee for service | ||
| Nevada | Yes | CN | No | Fee for service | ||
| New Hampshire | Yes | CN & MN | No | Fee for service using base rate plus mileage | ||
| New Jersey | Yes | CN & MN | No | Fee for service | ||
| New Mexico | Yes | CN | No | Fee for service | ||
| New York | Yes | CN & MN | No | Non-emergency transports by ambulance | Fee for service | |
| North Carolina | Yes | CN & MN | No | Specified services | Fee for service, public providers settled to federal share of cost annually | |
| North Dakota | Yes | CN & MN | No | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | Limited to transportation to on-island facilities | ||
| Ohio | Yes | CN | No | Fee for service | ||
| Oklahoma | Yes | CN | No | Limited to emergency transports | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | No | Services limited to funded conditions on the priority list | Fee for service, using a percentage of Medicare rates | |
| Pennsylvania | Yes | CN & MN | No | Fee for service | ||
| Puerto Rico | Yes | CN & MN | No | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | Yes | See state-specific FN | No | Fee for service | ||
| South Carolina | Yes | CN | No | Fee for service | ||
| South Dakota | Yes | CN | No | Fee for service | ||
| Tennessee | Yes | A, B & C - See state-specific FN | No | See state-specific FN | ||
| Texas | Yes | CN & MN | No | Non-emergency transports | Fee for service to all commercial providers, cost based supplemental payment to government providers | |
| Utah | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | No | Out-of-state transports | Fee for service | |
| U.S. Virgin Islands | Yes | CN | No | Air ambulance emergency only | Reasonable charge | |
| Virginia | Yes | CN & MN | No | Non-emergency transports | Fee for service | |
| Washington | Yes | CN & MN | No | Fee for service, cost based payment to one air ambulance provider | ||
| West Virginia | Yes | A, B & C | No | Fee for service, using Medicare payment ceilings | ||
| Wisconsin | Yes | CN & MN | $2/non-emergency ambulance trip, $1/trip in specialized medical vehicle | Fee for service | ||
| Wyoming | Yes | CN | No | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 8 No - 48 | ||||
| Alabama | Yes | CN | No | Fee for service | ||
| Alaska | Yes | CN | No | Fee for service, using Medicare upper limits | ||
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Fee for service | ||
| Arkansas | Yes | CN & MN | No | Fee for service | ||
| California | Yes | CN & MN | No | Fee for service | ||
| Colorado | Yes | CN | No | Fee for service | ||
| Connecticut | Yes | CN & MN | No | Fee for service | ||
| Delaware | Yes | CN | No | Fee for service, additional payment for more than 10 miles | ||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | $1/non-emergency trip | Non-emergency transports | Fee for service | |
| Georgia | Yes | CN & MN | No | 2 trips/day | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Guam | Yes | CN | No | Reasonable charge for off-island transport, federal Medicaid funds not claimed for on-island transport | ||
| Hawaii | Yes | CN & MN | No | Fee for service | ||
| Idaho | Yes | CN | $3/trip if determined an inappropriate use, except for tribal members and pregnant women | Non-emergency transports | Fee for service | |
| Illinois | Yes | CN & MN | No | Non-emergency transports by ambulance | Fee for service | |
| Indiana | Yes | CN | $.50-$2/non-emergency transport, depending on payment | Non-emergency transports or transports greater than 50 miles | Fee for service | |
| Iowa | Yes | CN & MN | $2/day for non-emergency transports | Fee for service | ||
| Kansas | Yes | CN & MN | $3/date of service for non-emergency trip | Reasonable charge with limits | ||
| Kentucky | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Louisiana | Yes | CN & MN | No | Non-emergency transports | Fee for service, using Medicare payment ceilings | |
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Fee for service | ||
| Maryland | Yes | CN & MN | No | Fee for service | ||
| Massachusetts | Yes | CN & MN | No | Fee for service | ||
| Michigan | Yes | CN & MN | No | Fixed wing transports and non-borderland out-of-state transports | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | No | Fee for service using Medicare unadjusted base rate | ||
| Mississippi | Yes | CN | $3/trip | Urgent fixed wing air ambulance transports | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | No | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | No | All transports must meet specified medical necessity criteria | Non-emergency transports | Fee for service |
| Nebraska | Yes | CN & MN | No | Fee for service | ||
| Nevada | Yes | CN | No | Fee for service | ||
| New Hampshire | Yes | CN & MN | No | Fee for service | ||
| New Jersey | Yes | CN & MN | No | Fee for service | ||
| New Mexico | Yes | CN | No | Fee for service | ||
| New York | Yes | CN & MN | No | Non-emergency transports by ambulance | Fee for service | |
| North Carolina | Yes | CN & MN | No | Fee for service for private providers, cost based payment for public providers | ||
| North Dakota | Yes | CN & MN | No | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | |||
| Ohio | Yes | CN | No | Fee for service | ||
| Oklahoma | Yes | CN | No | Limited to emergency transports | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | No | Services limited to funded conditions on the priority list | Fee for service, using a percentage of Medicare rates | |
| Pennsylvania | Yes | CN & MN | No | Fee for service | ||
| Puerto Rico | Yes | CN & MN | No | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | Yes | See state-specific FN | No | Fee for service | ||
| South Carolina | Yes | CN | No | Fee for service | ||
| South Dakota | Yes | CN | No | Fee for service | ||
| Tennessee | Yes | A & B - See state-specific FN | No | See state-specific FN | ||
| Texas | Yes | CN & MN | No | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | No | Out-of-state transports | Fee for service | |
| U.S. Virgin Islands | Yes | CN | No | Air ambulance emergency only | Reasonable charge | |
| Virginia | Yes | CN & MN | No | Non-emergency transports | Fee for service | |
| Washington | Yes | CN & MN | No | Fee for service | ||
| West Virginia | Yes | A, B & C | No | Fee for service, using Medicare payment ceilings | ||
| Wisconsin | Yes | CN & MN | $2/non-emergency ambulance trip, $1/trip in specialized medical vehicle | Fee for service | ||
| Wyoming | Yes | CN | No | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 8 No - 48 | ||||
| Alabama | Yes | CN | No | Fee for service | ||
| Alaska | Yes | CN | No | Fee for service, using Medicare upper limits | ||
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Fee for service | ||
| Arkansas | Yes | CN & MN | No | Fee for service | ||
| California | Yes | CN & MN | No | Fee for service | ||
| Colorado | Yes | CN | No | Fee for service | ||
| Connecticut | Yes | CN & MN | No | Fee for service | ||
| Delaware | Yes | CN | No | Fee for service, additional payment for more than 10 miles | ||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | $1/non-emergency trip | Non-emergency transports | Fee for service | |
| Georgia | Yes | CN & MN | No | 2 trips/day | Fee for service | |
| Guam | Yes | CN | No | Reasonable charge for off-island transport, federal Medicaid funds not claimed for on-island transport | ||
| Hawaii | Yes | CN & MN | No | Fee for service | ||
| Idaho | Yes | CN | $3/trip if determined an inappropriate use, except for tribal members | Non-emergency transports | Fee for service | |
| Illinois | Yes | CN & MN | No | Specified services | Fee for service | |
| Indiana | Yes | CN | $.50-$2/non-emergency transport, depending on payment | Non-emergency transports or transports greater than 50 miles | Fee for service | |
| Iowa | Yes | CN & MN | $2/day for non-emergency transports | Fee for service | ||
| Kansas | Yes | CN & MN | $3/date of service for non-emergency trip | Reasonable charge with limits | ||
| Kentucky | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Louisiana | Yes | CN & MN | No | Fee for service, using Medicare payment ceilings | ||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Fee for service | ||
| Maryland | Yes | CN & MN | No | Fee for service | ||
| Massachusetts | Yes | CN & MN | No | Fee for service | ||
| Michigan | Yes | CN & MN | No | Fixed wing transport | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | No | Fee for service using Medicare unadjusted base rate | ||
| Mississippi | Yes | CN | $3/trip | Urgent fixed wing air ambulance transports | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | No | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | No | All transports must meet specified medical necessity criteria | Non-emergency transports | Fee for service |
| Nebraska | Yes | CN & MN | No | Fee for service | ||
| Nevada | Yes | CN | No | Fee for service | ||
| New Hampshire | Yes | CN & MN | No | Fee for service | ||
| New Jersey | Yes | CN & MN | No | Fee for service | ||
| New Mexico | Yes | CN | No | Fee for service | ||
| New York | Yes | CN & MN | No | Fee for service | ||
| North Carolina | Yes | CN & MN | No | Fee for service for private providers, cost based payment for public providers | ||
| North Dakota | Yes | CN & MN | No | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | |||
| Ohio | Yes | CN | No | Fee for service | ||
| Oklahoma | Yes | CN | No | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | No | Fee for service | ||
| Pennsylvania | Yes | CN & MN | No | Fee for service | ||
| Puerto Rico | Yes | CN & MN | No | Fee for service for contracted staff | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Fee for service | ||
| South Carolina | Yes | CN | No | Fee for service | ||
| South Dakota | Yes | CN | No | Fee for service | ||
| Tennessee | Yes | A & B - See state-specific FN | No | |||
| Texas | Yes | CN & MN | No | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | No | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | No | Air ambulance emergency only | Reasonable charge | |
| Virginia | Yes | CN & MN | No | Non-emergency transports | Fee for service | |
| Washington | Yes | CN & MN | No | Fee for service | ||
| West Virginia | Yes | A, B & C | No | Fee for service, using Medicare payment ceilings | ||
| Wisconsin | Yes | CN & MN | $2/non-emergency ambulance trip, $1/trip in specialized medical vehicle | Fee for service | ||
| Wyoming | Yes | CN | No | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 7 No - 49 | ||||
| Alabama | Yes | CN | No | Fee for service | ||
| Alaska | Yes | CN | No | Fee for service, using Medicare upper limits | ||
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Fee for service | ||
| Arkansas | Yes | CN & MN | No | Fee for service | ||
| California | Yes | CN & MN | No | Fee for service | ||
| Colorado | Yes | CN | No | Fee for service | ||
| Connecticut | Yes | CN & MN | No | Fee for service | ||
| Delaware | Yes | CN | No | Fee for service, additional payment for more than 10 miles | ||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | $1/non-emergency trip | Non-emergency transports | Fee for service | |
| Georgia | Yes | CN & MN | No | 2 trips/day | Fee for service, negotiated rate for air transport | |
| Guam | Yes | CN | No | Reasonable charge for off-island transport, federal Medicaid funds not claimed for on-island transport | ||
| Hawaii | Yes | CN & MN | No | Fee for service | ||
| Idaho | Yes | CN | No | Non-emergency transports | Reasonable charge, using Medicare payment limits | |
| Illinois | Yes | CN & MN | No | Specified services | Fee for service | |
| Indiana | Yes | CN | $.50-$2/non-emergency transport, depending on payment | Non-emergency transports or transports greater than 50 miles | Fee for service | |
| Iowa | Yes | CN & MN | $2/day for non-emergency transports | Fee for service | ||
| Kansas | Yes | CN & MN | $3/date of service for non-emergency trip | Reasonable charge with limits | ||
| Kentucky | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Louisiana | Yes | CN & MN | No | Fee for service, using Medicare payment ceilings | ||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Fee for service | ||
| Maryland | Yes | CN & MN | No | Fee for service | ||
| Massachusetts | Yes | CN & MN | No | Fee for service | ||
| Michigan | Yes | CN & MN | No | Fixed wing transport | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | No | Fee for service using Medicare unadjusted base rate | ||
| Mississippi | Yes | CN | $3/trip | Urgent fixed wing air ambulance transports | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | No | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | No | All transports must meet specified medical necessity criteria | Non-emergency transports | Fee for service |
| Nebraska | Yes | CN & MN | No | Fee for service | ||
| Nevada | Yes | CN | No | Fee for service | ||
| New Hampshire | Yes | CN & MN | No | Fee for service | ||
| New Jersey | Yes | CN & MN | No | Fee for service | ||
| New Mexico | Yes | CN | No | Fee for service | ||
| New York | Yes | CN & MN | No | Fee for service | ||
| North Carolina | Yes | CN & MN | No | Fee for service for private providers, cost based payment for public providers | ||
| North Dakota | Yes | CN & MN | No | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | |||
| Ohio | Yes | CN | No | Fee for service | ||
| Oklahoma | Yes | CN | No | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | No | Fee for service | ||
| Pennsylvania | Yes | CN & MN | No | Fee for service with payment for multiple-person transport limited to mileage for person transported farthest | ||
| Puerto Rico | Yes | CN & MN | No | Fee for service for contracted staff | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Fee for service | ||
| South Carolina | Yes | CN | No | Fee for service | ||
| South Dakota | Yes | CN | No | Fee for service | ||
| Tennessee | Yes | A & B - See state-specific FN | No | |||
| Texas | Yes | CN & MN | No | Fee for service | ||
| Utah | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | No | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | No | Air ambulance emergency only | Reasonable charge | |
| Virginia | Yes | CN & MN | No | Fee for service | ||
| Washington | Yes | CN & MN | No | Fee for service | ||
| West Virginia | Yes | CN & MN | No | Fee for service, using Medicare payment ceilings | ||
| Wisconsin | Yes | CN & MN | $2/non-emergency ambulance trip, $1/trip in specialized medical vehicle | Fee for service | ||
| Wyoming | Yes | CN | No | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 7 No - 49 | ||||
| Alabama | Yes | CN | No | Fee for service | ||
| Alaska | Yes | CN | No | Reasonable charge, with limits | ||
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Fee for service | ||
| Arkansas | Yes | CN & MN | No | Fee for service | ||
| California | Yes | CN & MN | No | Fee for service | ||
| Colorado | Yes | CN | No | Fee for service | ||
| Connecticut | Yes | CN & MN | No | Fee for service | ||
| Delaware | Yes | CN | No | Fee for service, additional payment for more than 10 miles | ||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | $1/non-emergency trip | Non-emergency transports | Fee for service | |
| Georgia | Yes | CN & MN | No | 2 trips/day | Fee for service, negotiated rate for air transport | |
| Guam | Yes | CN | No | Reasonable charge for off-island transport, federal Medicaid funds not claimed for on-island transport | ||
| Hawaii | Yes | CN & MN | No | Fee for service | ||
| Idaho | Yes | CN | No | Non-emergency transports | Reasonable charge, using Medicare payment limits | |
| Illinois | Yes | CN & MN | No | Specified services | Fee for service | |
| Indiana | Yes | CN | $.50-$2/non-emergency transport, depending on payment | Non-emergency transports or transports greater than 50 miles | Fee for service | |
| Iowa | Yes | CN & MN | $2/day for non-emergency transports | Fee for service | ||
| Kansas | Yes | CN & MN | $3/date of service for non-emergency trip | Reasonable charge with limits | ||
| Kentucky | Yes | CN & MN | No | Fee for service | ||
| Louisiana | Yes | CN & MN | No | Fee for service, using Medicare payment ceilings | ||
| Maine | Yes | CN & MN | $.50-$3/day, depending on payment, up to $30/month | Fee for service | ||
| Maryland | Yes | CN & MN | No | Fee for service | ||
| Massachusetts | Yes | CN & MN | No | Fee for service | ||
| Michigan | Yes | CN & MN | No | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | No | Fee for service using Medicare unadjusted base rate | ||
| Mississippi | Yes | CN | $3/trip | Urgent fixed wing air ambulance transports | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | No | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | No | All transports must meet specified medical necessity criteria | Non-emergency transports | Fee for service |
| Nebraska | Yes | CN & MN | No | Fee for service | ||
| Nevada | Yes | CN | No | Fee for service | ||
| New Hampshire | Yes | CN & MN | No | Fee for service | ||
| New Jersey | Yes | CN & MN | No | Fee for service | ||
| New Mexico | Yes | CN | No | Fee for service | ||
| New York | Yes | CN & MN | No | Fee for service | ||
| North Carolina | Yes | CN & MN | No | Fee for service for private providers, cost based payment for public providers | ||
| North Dakota | Yes | CN & MN | No | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | |||
| Ohio | Yes | CN | No | Fee for service | ||
| Oklahoma | Yes | CN | No | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | No | Fee for service | ||
| Pennsylvania | Yes | CN & MN | No | Fee for service with payment for multiple-person transport limited to mileage for person transported farthest | ||
| Puerto Rico | Yes | CN & MN | No | Cost based payment using all-inclusive rate | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Fee for service | ||
| South Carolina | Yes | CN | No | Fee for service | ||
| South Dakota | Yes | CN | No | Fee for service | ||
| Tennessee | Yes | A & B - See state-specific FN | No | |||
| Texas | Yes | CN & MN | No | Fee for service using regional rates | ||
| Utah | Yes | A, B & C - See state-specific FN | No | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | No | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | No | Air ambulance emergency only | Reasonable charge | |
| Virginia | Yes | CN & MN | No | Fee for service | ||
| Washington | Yes | CN & MN | No | Fee for service | ||
| West Virginia | Yes | CN & MN | No | Fee for service, using Medicare payment ceilings | ||
| Wisconsin | Yes | CN & MN | $2/non-emergency ambulance trip, $1/trip in specialized medical vehicle | Fee for service | ||
| Wyoming | Yes | CN | No | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 7 No - 49 | ||||
| Alabama | Yes | CN | No | Fee for service | ||
| Alaska | Yes | CN | No | Reasonable charge, with limits | ||
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Fee for service | ||
| Arkansas | Yes | CN & MN | No | Fee for service | ||
| California | Yes | CN & MN | No | Fee for service | ||
| Colorado | Yes | CN | No | Fee for service | ||
| Connecticut | Yes | CN & MN | No | Fee for service | ||
| Delaware | Yes | CN | No | Fee for service, additional payment for more than 10 miles | ||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | $1/non-emergency trip | Non-emergency transports | Fee for service | |
| Georgia | Yes | CN & MN | No | 2 trips/day | Fee for service, negotiated rate for air transport | |
| Guam | Yes | CN | No | Reasonable charge for off-island transport, federal Medicaid funds not claimed for on-island transport | ||
| Hawaii | Yes | CN & MN | No | Fee for service | ||
| Idaho | Yes | CN | No | Non-emergency transports | Reasonable charge, using Medicare payment limits | |
| Illinois | Yes | CN & MN | No | Specified services | Fee for service | |
| Indiana | Yes | CN | $.50-$2/non-emergency transport, depending on payment | Non-emergency transports or transports greater than 50 miles | Fee for service | |
| Iowa | Yes | CN & MN | $2/day for non-emergency transports | Fee for service | ||
| Kansas | Yes | CN & MN | $3/date of service for non-emergency trip | Reasonable charge with limits | ||
| Kentucky | Yes | CN & MN | No | Fee for service | ||
| Louisiana | Yes | CN & MN | No | Fee for service, using Medicare payment ceilings | ||
| Maine | Yes | CN & MN | $.50-$3/trip, depending on payment, up to $30/month | Fee for service | ||
| Maryland | Yes | CN & MN | No | Fee for service | ||
| Massachusetts | Yes | CN & MN | No | Fee for service | ||
| Michigan | Yes | CN & MN | No | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | No | Fee for service using Medicare unadjusted base rate | ||
| Mississippi | Yes | CN | $3/trip | Urgent fixed wing air ambulance transports | Fee for service, using a percentage of Medicare allowable payment as ceiling | |
| Missouri | Yes | CN | No | Fee for service | ||
| Montana | Yes | CN & MN | No | All transports must meet specified medical necessity criteria | Non-emergency transports | Fee for service |
| Nebraska | Yes | CN & MN | No | Fee for service | ||
| Nevada | Yes | CN | No | Fee for service | ||
| New Hampshire | Yes | CN & MN | No | Fee for service | ||
| New Jersey | Yes | CN & MN | No | Fee for service | ||
| New Mexico | Yes | CN | No | Fee for service | ||
| New York | Yes | CN & MN | No | Fee for service | ||
| North Carolina | Yes | CN & MN | No | Fee for service for private providers, cost based payment for public providers | ||
| North Dakota | Yes | CN & MN | No | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific | No | |||
| Ohio | Yes | CN | No | Fee for service | ||
| Oklahoma | Yes | CN & MN | No | Fee for service | ||
| Oregon | Yes | CN & MN | No | Fee for service | ||
| Pennsylvania | Yes | CN & MN | No | Fee for service with payment for multiple-person transport limited to mileage for person transported farthest | ||
| Puerto Rico | Yes | CN & MN | No | Cost based payment using all-inclusive rate | ||
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Fee for service | ||
| South Carolina | Yes | CN | No | Fee for service | ||
| South Dakota | Yes | CN | No | Fee for service | ||
| Tennessee | Yes | A & B - See state-specific FN | No | |||
| Texas | Yes | CN & MN | No | Fee for service using regional rates | ||
| Utah | Yes | A, B & C - See state specific FN | No | Fee for service | ||
| Vermont | Yes | A & B - See state-specific FN | No | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | No | Air ambulance emergency only | Reasonable charge | |
| Virginia | Yes | CN & MN | No | Fee for service | ||
| Washington | Yes | CN & MN | No | Fee for service | ||
| West Virginia | Yes | CN & MN | No | Fee for service, using Medicare payment ceilings | ||
| Wisconsin | Yes | CN & MN | $2/non-emergency trip | Fee for service | ||
| Wyoming | Yes | CN | No | Fee for service |