CG-ANC-05 Ambulance Services: Ground; Emergent

This policy addresses coverage for emergency ground ambulance transport. It is covered when the ambulance is properly equipped, the patient’s condition makes any other transport medically contraindicated, and the trip is either from the scene of a life‑threatening emergency to the nearest appropriate facility or an emergent interfacility transfer (e.g., hospital, skilled nursing facility, or free‑standing dialysis center) for medically necessary diagnostic or therapeutic services. It is not covered when these criteria are not met, when used for convenience or to transport a deceased individual, and mileage beyond the distance to the nearest appropriate facility is not covered.

"The use of emergency ground ambulance services is consideredmedically necessarywhenallthe following criteria are met:"

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