For Ambulance Services During The PPS Period

Ambulance Bills:
 Type of TripPart B CarrierFacility
1. Initial Admission to SNFX
2. Final Discharge from SNF:
2a. To home (no return same day)X
2b. To home (return to same SNF same day)X
2c. To another SNF, including for elevated level of careX*
3. Inpatient Hospital Admission:

3a. To hospital from SNF admissionX
3b. To SNF from hospital (i.e. discharge)X
4. Trip to Beneficiary's Home for Medicare Home Health ServicesX
5. Transports to/from dialysisX
6. Trip to Hospital for Outpatient Services:
6a. Transports for all services other than those listed in 6b below, must be billed to the facility, including:

Physical, Occupational, Speech Therapy
Diagnostic Tests or Services Routinely Provided by SNFs
Evaluation or Treatment Services (other than a hospital admission or one of the outpatient services listed in 6b below)
X
6b. The following trips to a hospital for outpatient services should be billed to Part B, if for:

• Emergency
• Cardiac Catherization
• CT Scans
• MRI
• Ambulatory Surgery** Involving Operating Room (this includes PEG tube procedures, even if performed in a hospital GI suite or endoscopy suite)
• Angiography
• Lymphatic and venous procedure
• Radiation therapy

NOTE: ALL SERVICES IN 6B MUST BE PERFORMED AT THE HOSPITAL (NOT A FREE-STANDING FACILITY) FOR YOU TO BILL YOUR CARRIER. IF NOT PERFORMED AT THE HOSPITAL, THE SNF/SWING BED FACILITY IS RESPONSIBLE
X
7. Transports to any Medicare Provider for chemotherapy, chemotherapy administration, radioisotopes, customized prosthetic devices, barium swallow, hyperbaric oxygen, transfusionX
8. Transports to a physician's office (only during a Part A stay)X

* Discharge Facility is responsible

** Minor procedures that can safely be performed by SNF are not billable to Part B. An updated list of these minor procedures, arranged by HCPCS procedure code, can be found at:

http://www.cms.hhs.gov/SNFConsolidatedBiling/80_2006_FI_Update.asp

REMINDER, IF THE SERVICES ARE NOT SPECIFICALLY LISTED ABOVE AS BILLABLE TO THE CARRIER, IT IS THE RESPONSIBILITY OF THE FACILITY.

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