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Understanding TRICARE’s Ambulance Coverage  (Article 1)
When an Ambulance Is Covered

Ambulance transfers are covered in the following circumstances:
 
  • Emergency transfers to or from a beneficiary’s home, accident scene or other location to a civilian hospital, military treatment facility (MTF) or Department of Veterans Affairs (VA) hospital
  • Emergency transfers between MTFs, VA hospitals and civilian hospitals
  • Transfers from a hospital-based emergency room to an MTF, VA hospital or civilian hospital that is more capable of providing the care
  • Transfers from an MTF/civilian hospital/skilled nursing facility to a freestanding or other hospital-based outpatient therapeutic or diagnostic department/facility
  • Transfers to and from a skilled nursing facility and a civilian hospital/MTF/VA hospital when medically necessary


When It’s by Boat, Airplane or Helicopter

Ambulance services using “other-than-land” vehicles such as a boat, airplane or helicopter are covered only when:
   
  • The pick-up point is inaccessible by a land vehicle
  • Great distance or other obstacles are involved in transporting the patient
  • The patient’s medical condition warrants speedy admission to an emergency room

If the ambulance service received a call and dispatched Advanced Life Support (ALS) even though Basic Life Support (BLS) was available, then BLS will be paid if the patient’s condition could have been managed by BLS service.

There must be justification on the claim supporting the use of ALS in areas where both ALS and BLS ambulances are available and no state laws or local ordinances mandate ALS as the minimum standard transport.

When an Ambulance Is Not Covered

TRICARE does not cover ambulance services for the following:

   
  • Nonemergency ambulance services used instead of a taxi service or other normal transportation means when the patient’s condition would permit use of regular transportation
  • Transport or transfer of a patient primarily for the purpose of having the patient closer to home, family, friends or a physician
  • Any type of medicabs or ambicabs, which function as public passenger services transporting patients to and from their medical appointments

Please be aware that transportation may be covered in certain circumstances for beneficiaries using the TRICARE Extended Care Health Option (ECHO). Contact Humana Military for details.
 

 Billing for Ambulance Services
Be certain to use a modifier code with two characters indicating the origination and destination of the ambulance transport. 
  • H - Hospital
  • R - Residence
  • P - Physician’s office
  • S - Scene
  • E - Extended care facility
For example, the modifier HH indicates a trip from one hospital to another, while PH stands for a trip from physician’s office to hospital. These modifiers help Humana Military process ambulance claims accurately.
 


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Last Reviewed:  February 1, 2007