Medicare Ground Ambulance Data Collection System

From 2020 through 2024, CMS selected ground ambulance providers and suppliers to participate in the Medicare Ground Ambulance Data Collection System (GADCS).

Key Takeaways

• CMS selected participating organizations and organized them into four cohorts.

• Participants collected data oncosts, revenue, utilization, and other information over a continuous 12‑monthperiod.

• Organizations submitted data through the GADCS portal within five months after their data collection period ended.

• CMS provided resources and tools to support accurate and timely reporting.

• Organizations that failed to report required data may receive a 10 percent reduction in Medicare payments under the Medicare Part B Ambulance Fee Schedule, for the following calendar year unless CMS approved a hardship exemption or informal review request.

• The collected information will be provided to the Medicare Payment Advisory Commission (MedPAC), which is required to submit a report to Congress on the adequacy of Medicare payment rates for ground ambulance services and geographic variations in the cost of furnishing such services. MedPAC is an independent federal body established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program.

Policy References

Calendar Year (CY) 2026 Physician Fee Schedule (PFS) Final Rule 

CMS issued the CY 2026 PFS final rule that announces the finalized policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues including ambulance services. Section 2203 of the Full-Year Continuing Appropriations and Extensions Act, 2025 (Pub. L. 119-4, March 15, 2025) extended three existing add-on payments to the ambulance base and mileage rates under the Ambulance Fee Schedule for ground ambulance transports through September 30, 2025. Accordingly, CMS finalized the proposals to revise our regulations at 42 CFR §414.610(c)(1)(ii) and 414.610(c)(5)(ii) in this final rule to align with existing law.

Rules

Rule Title	Key Highlights	Fact Sheet
CY 2024 PFS Final Rule	Finalized CMS’ proposals for the following changes to the GADCS instrument: Adding the ability to address partial year responses from ground ambulance organizations Introducing a minor edit to improve the reporting consistency of hospital-based ambulance organizations Four technical corrections to typos	Fact Sheet: CY 2024 PFS Final Rule
CY 2024 PFS Proposed Rule	Proposed the following changes to the GADCS instrument: Adding the ability to address partial year responses from ground ambulance organizations Introducing a minor edit to improve the reporting consistency of hospital-based ambulance organizations Four technical corrections to typos	Fact Sheet: CY 2024 PFS Proposed Rule
CY 2023 PFS Final Rule	CMS finalized the following proposals for the GADCS:  Update our regulations at § 414.626(d)(1) and (e)(2) to provide the necessary flexibility to specify how ground ambulance organizations should submit the hardship exemption requests and informal review requests, including to our web-based portal once that portal is operational. Clarifications to the GADCS Instrument. The changes and clarifications aim to reduce burden on respondents, improve data quality, or both. We grouped these changes and clarifications into four broad categories: editorial changes for clarity and consistency; updates to reflect the web-based system; clarifications responding to feedback from questions from interested parties and testing; and typos and technical corrections.	Fact Sheet: CY 2023 PFS Final Rule
CY 2023 PFS Proposed Rule	CMS proposed the following changes to the GADCS:  Proposed to update our regulations at 414.626(d)(1) and (e)(2) to provide the necessary flexibility to specify how ground ambulance organizations should submit the hardship exemption requests and informal review requests, including to our web-based portal once that portal is operational. Proposed clarifications to the GADCS Instrument. The changes and clarifications aim to reduce burden on respondents, improve data quality, or both. We grouped these changes and clarifications into four broad categories: editorial changes for clarity and consistency; updates to reflect the web-based system; clarifications responding to feedback from questions from interested parties and testing; and typos and technical corrections.	Fact Sheet: CY 2023 PFS Proposed Rule
CY 2022 PFS Final Rule	Finalized our proposed changes to the GADCS including:  Finalized our proposal for a new data collection period beginning between January 1, 2023, and December 31, 2023, and a new data reporting period beginning between January 1, 2024, and December 31, 2024, for selected ground ambulance organizations in year 3; Finalized our revisions to the timeline for when the payment reduction for failure to report will begin aligning the timelines for the application of penalties for not reporting data with our new timelines for data collection and reporting and when the data will be publicly available beginning in 2024; and Finalized our revisions to the Medicare Ground Ambulance Data Collection Instrument. These changes and clarifications to the instrument will improve its clarity and make the instrument less burdensome for respondents to complete.	Fact Sheet: CY 2022 PFS Final Rule
CY 2022 PFS Proposed Rule	CMS proposed a series of changes to the GADCS including: Proposed changes to the data collection period and data reporting period for selected ground ambulance organizations in year three;   Proposed revisions to the timeline for when the payment reduction for failure to report will begin and when the data will be publicly available; and Proposed revisions to the Medicare Ground Ambulance Data Collection Instrument. Through review of questions and feedback that we received, we have identified some instances where changes and clarifications to the instrument could improve clarity and be less burdensome to respondents.	Fact Sheet: CY 2022 PFS Proposed Rule
CY 2020 PFS Final Rule	CMS finalized these proposals for the GADCS: Data collection format and elements with some modifications based on comments received. Sampling methodology that CMS will use to identify ground ambulance organizations for reporting each year through 2024 and not less than every 3 years after 2024, Data collection and reporting timeframes that selected ground ambulance organizations will need to satisfy. 10 Percent Payment Reduction: Ground ambulance organizations that are selected to report, but fail to sufficiently submit the required data, will be applied a 10% reduction to payments made under the Ambulance Fee Schedule unless they are granted a hardship exemption by CMS.	Fact Sheet: CY 2020 PFS Final Rule
CY 2020 PFS Proposed Rule	Section 50203 (b) of the Bipartisan Budget Act (BBA) of 2018 requires the Secretary to develop a data collection system to collect cost, revenue, utilization, and other information determined appropriate with respect to ground ambulance providers suppliers. CMS proposed the establishment of the GADCS to meet the statutory requirement: Proposed the data collection format and elements, Proposed a sampling methodology to identify ground ambulance organizations for reporting each year through 2024 and not less than every 3 years after 2024, and reporting timeframes. Proposed a 10% payment reduction in payments that would otherwise be made to a ground ambulance organization that is identified for reporting but fails to sufficiently submit data, Proposed a process under which a ground ambulance organization can request a hardship exemption or informal review that, if granted by CMS would allow it to avoid the payment reduction.	Fact Sheet: CY 2020 PFS Proposed Rule