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Ambulance Fee Schedule

Proposed Rule for Payment under the Ambulance Fee Schedule (AFS)

published 5/26/06 (See AFS Regulations and Notices link.)

Section 4531 (b) (2) of the Balanced Budget Act (BBA) of 1997 added a new section 1834 (l) 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.

Section 1834 (l) also requires mandatory assignment for all ambulance services. Ambulance providers and suppliers must accept the Medicare allowed charge as payment in full and not bill or collect from the beneficiary any amount other than any unmet Part B deductible and the Part B coinsurance amounts.

A cover sheet is provided with every year's PUF giving detailed information concerning the amounts payable and any special circumstances pertinent for that year's payments.

National Breakout of Geographic Area Definitions by Zip Code

CY2007:

In response to several requests from the ambulance community for a national breakout of the geographic area definitions (rural, urban, and super rural) by zip code, we have prepared a table (see Downloads section below). Please note that it is arranged by State (using each State's two-letter postal abbreviation), and, within each State, all zip codes are listed. There are two sides to the table – the current geographic area breakout on the left and the geographic area breakout under the Proposed Rule, which was published on May 26, 2006 on the right. The Medicare contractor number and the locality are also included. Please note that, in the far right column for each side of the table, R = Rural, Blank = Urban, and B = Super Rural.  None of the Super Rural areas has changed.  Please search for your State, then zip code within the State, and compare the two sides of the table to determine if your geographic area definition changes under the Proposed Rule discussion.

CY 2015 Proposed Rule:

In the CY 2015 Physician Fee Schedule (PFS) proposed rule (79 FR 40376); CMS proposed to implement the new OMB delineations as described in the February 28, 2013 OMB Bulletin No. 13-01 based on 2010 Census to more accurately identify urban and rural areas for ambulance fee schedule payment purposes. We have prepared tables identifying the zip codes that would be affected by these proposed changes (see Downloads section below).

CY 2015 Final Rule:

In the CY 2015 PFS final rule, http://www.ofr.gov/OFRUpload/OFRData/2014-26183_PI.pdf  CMS finalized our proposals to adopt, beginning in CY 2015, the revised OMB delineations as set forth in OMB’s February 28, 2013 bulletin (No. 13-01) and the most recent modifications of the RUCA codes for purposes of payment under the ambulance fee schedule.  As we proposed, using the updated RUCA codes definitions, we will continue to designate any census tracts falling at or above RUCA level 4.0 as rural areas.  None of the current super rural areas will lose their super rural status upon implementation of the revised OMB delineations and the updated RUCA codes.   We have prepared the following tables: ZIP codes by state that changed from urban to rural, ZIP codes by state that changed from rural to urban, list of ZIP codes with RUCA code designations, and a complete list of ZIP codes identifying their designation as super rural, rural or urban. (see Downloads section below).

Ambulance Services Center

For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) ambulance suppliers, go to the Ambulance Services Center (see under "Related Links Inside CMS" below).