S9961, Ambulance service, conventional air service, nonemergency transport, one way
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Providers must reference the most up-to-date professional coding guidance prior to claim submission.
- Clinical documentation demonstrating that ground transport would endanger the patient (vital signs, mechanism of injury, clinical findings)
- Documentation of why the receiving facility is required (facility capability, specialty services) and that timely care cannot be achieved by ground transport
- EMS/transport run report noting pickup location, inability or contraindication for ground transport, and estimated ground vs air transport times
Key Coverage Criteria
- The individualâs condition must be such that any form of transportation other than by ambulance would be medically contraindicated;and
- The ambulance must have the necessary equipment and supplies to address the needs of the individual;and
- The use of air and water ambulance services is consideredmedically necessarywhenallthe following criteria are met:
- Transportation to thenearest* appropriate facility for treatment of an individualâs illness or injury when either of the following circumstances exists:Scene of an accident or emergency when there is a medical condition that is life-threatening or first responders (for example, law enforcement officers, emergency medical services members, or fire services members) deem to be life-threatening;orFrom one facility to another when the first facility does not have the required services to treat the [...]
- Scene of an accident or emergency when there is a medical condition that is life-threatening or first responders (for example, law enforcement officers, emergency medical services members, or fire services members) deem to be life-threatening;or
- From one facility to another when the first facility does not have the required services to treat the individual;and
8 Active Policies
ANTHEM-CG-ANC-04, CG-ANC-04 Ambulance Services: Air and Water
AMBETTER-CP.MP.175, Air Ambulance
ADM1001.005, Ambulance and Transport Services
BCBSIL-MED201.058, Ambulance and Transport Services
BCBSMT-MED201.058, Ambulance and Transport Services
Related Codes
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