The Centers for Medicare & Medicaid Services (CMS) has issued Pub. 100-04, Transmittal# 789, Change Request (CR#) 4221. This document, dated December 23, 2005, furnishes you with the Ambulance Medical Conditions List and its instructions.

The “Medical Conditions List” is intended primarily as an educational guideline. It will help ambulance providers and suppliers to communicate the patient’s condition to Medicare contractors, as reported by the dispatch center and as observed by the ambulance crew.

Use of the Medical Conditions List information does not guarantee payment of the claim or payment for a certain level of service. Ambulance providers and suppliers must retain adequate documentation of dispatch instructions, patient’s condition, and miles traveled, all of which must be available in the event the claim is selected for medical review (MR) by the Medicare contractor or other oversight authority. Medicare contractors will rely on medical record documentation to justify coverage. The Healthcare Common Procedure Coding System (HCPCS) code or the Medical Conditions List information by themselves are not sufficient to justify coverage. All current Medicare ambulance policies remain in place.

The Medical Conditions List and entire text of this transmittal can be viewed at http://www.cms.hhs.gov/Transmittals/Downloads/R789CP.pdf.

Posted: 12/30/2005

CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.