Guidelines

Medicare’s Definition of Bed-Confined
There is now a national definition of the term "bed-confined." The patient must meet all of the following criteria:

• Unable to get up from bed without assistance.
• Unable to ambulate .
• Unable to sit in a chair or wheelchair.

Note: the term "bed-confined" is not synonymous with "bed rest" or "non-ambulatory".

In addition, "bed confined" is not meant to be the sole criteria to be used in determining if the patient must be transported by ambulance. It is one factor to be considered when making coverage determinations.

Non-Covered Services Defined by Medicare
Medicare does not cover the following services:

• Transportation in
• Ambi-buses
• Ambulettes (Mobility Vehicle-MAV)
• Medi-cabs
• Vans
• Privately owned vehicles
• Taxicabs
• Wheelchair vans
• Parking fees
• Tolls for bridges, tunnels or highways

Medicare National Fee Schedule
Section 4531 (b) (2) of the Balanced Budget Act (BBA) of 1997 added a new section 1834 (1) to the Social Security Act which mandated the implementation of a national fee schedule for ambulance services furnished as a benefit under Medicare Part B. The fee schedule is effective for claims with dates of service on or after April 1, 2002, and it applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers, i.e., hospitals, critical access hospitals (except when it is the only ambulance service within 35 miles), and skilled nursing facilities.