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Air Ambulance | |
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Description: |
Air ambulance transport services utilizing specially designed and equipped airplanes or helicopters are important in providing rapid medical care and transport of ill or injured patients. These air medical services may be involved in a primary response—transporting a patient from an original scene to the nearest facility capable of providing the medical care required, or a secondary response—involving an interfacility transport due to the patient's need for continuing care or a higher level of care than is available at the original facility.
Air ambulance providers must comply with all local, state, and federal laws and must have all the appropriate, valid licenses and permits.
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Policy/ Coverage: |
For some contracts, this service is a contract specific benefit. Additional restrictions may apply to members with contracts with limitations or exclusions for air medical transport.
Effective May 2023
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
Emergency Air Ambulance Transport:
A. Emergency air ambulance transport from site of accident, injury, or illness meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when the patient is in critical condition and/or has unstable vital signs, respiratory status, or cardiac status, including but not limited to ONE of the following conditions:
AND
ONE of the following:
B. Emergency air ambulance transport services from a Health Care Facility/Hospital Emergency Department or Inpatient Setting meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when ALL the following criteria are met:
C. Emergency air ambulance meets member benefit certificate primary coverage criteria for a deceased individual when either:
Non-Emergency Air Ambulance Transport:
A. Non-emergency air ambulance medical transportation from a Health Care Facility/Hospital Emergency Department or Inpatient Setting to an equivalent or higher level of acuity facility meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when ALL the following criteria are met:
B. Non-emergency following stabilization. Air ambulance medical transportation from a Health Care Facility/Hospital Emergency Department or Inpatient Setting to an equivalent or higher level of acuity facility meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when ALL the following criteria are met:
Air ambulance medical transportation meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes for the following indications:
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
Emergency air ambulance for transfer of a deceased individual to funeral home, morgue, or hospital when pronounced dead at the scene prior to dispatch of the air ambulance does not meet member benefit certificate primary coverage criteria.
For members with contracts without primary coverage criteria, emergency air ambulance for transfer of a deceased individual to funeral home, morgue, or hospital when pronounced dead at the scene prior to dispatch of the air ambulance is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Non-emergency air ambulance medical transportation provided primarily for the convenience of the patient, the patient’s family/caregivers or physician, or the transferring facility, including situations where long distances exist between the transferring and receiving facilities, does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, non-emergency air ambulance medical transportation provided primarily for the convenience of the patient, the patient’s family/caregivers or physician, or the transferring facility, including situations where long distances exist between the transferring and receiving facilities, is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Air Ambulance transport for all other indications and situations not described above as covered does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, Air Ambulance transport for all other indications and situations not described above as covered is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Effective October 2022 through April 2023
For some contracts, this service is a contract specific benefit. Additional restrictions may apply to members with contracts with limitations or exclusions for air medical transport.
Effective January 1, 2023, Prior Authorization is required for ALL Non-Emergency Air Ambulance Transport Services
As per Arkansas Code § 23-99-1107, no prior authorization for transport services shall be required when the requested transportation is in response to the presence of a medical emergency.
Meets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria
Emergency Air Ambulance Transport:
A. Emergency air ambulance transport from site of accident, injury, or illness meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when the patient is in critical condition and/or has unstable vital signs, respiratory status, or cardiac status, including but not limited to ONE of the following conditions:
AND
ONE of the following:
B. Emergency air ambulance transport services from a Health Care Facility/Hospital Emergency Department or Inpatient Setting meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when ALL the following criteria are met:
C. Emergency air ambulance meets member benefit certificate primary coverage criteria for a deceased individual when either:
Any situations not meeting the criteria for emergency air ambulance transport from site of accident or from Health Care Facility/Hospital Emergency Department or Inpatient Setting are considered non-emergency situations and require prior authorization.
Non-Emergency Air Ambulance Transport:
D. Non-emergency air ambulance medical transportation from a Health Care Facility/Hospital Emergency Department or Inpatient Setting to an equivalent or higher level of acuity facility meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when ALL the following criteria are met:
E. Non-emergency following stabilization. Air ambulance medical transportation from a Health Care Facility/Hospital Emergency Department or Inpatient Setting to an equivalent or higher level of acuity facility meets member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes when ALL the following criteria are met:
F. Air ambulance transport for patients seeking hospice care closer to home and for any unusual or uncommon circumstances involving frequent or recurrent air transport must be reviewed for appropriateness by the prior authorization services Medical Director.
Prior authorized air ambulance request may be submitted and reviewed for additional circumstances not detailed above. An authorized Medical Director may approve services based on the individual’s needs to manage the overall care of the member, including but not limited to:
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
Emergency air ambulance for transfer of a deceased individual to funeral home, morgue, or hospital when pronounced dead at the scene prior to dispatch of the air ambulance does not meet member benefit certificate primary coverage criteria.
For members with contracts without primary coverage criteria, emergency air ambulance for transfer of a deceased individual to funeral home, morgue, or hospital when pronounced dead at the scene prior to dispatch of the air ambulance is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Non-emergency air ambulance medical transportation provided primarily for the convenience of the patient, the patient’s family/caregivers or physician, or the transferring facility, including situations where long distances exist between the transferring and receiving facilities, does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, non-emergency air ambulance medical transportation provided primarily for the convenience of the patient, the patient’s family/caregivers or physician, or the transferring facility, including situations where long distances exist between the transferring and receiving facilities, is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Air Ambulance transport for all other indications and situations not described above as covered does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, Air Ambulance transport for all other indications and situations not described above as covered is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
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Rationale: |
Ambulance transport services involve the use of specially designed and equipped vehicles to transport ill or injured individuals. Ambulance transport may involve the movement of an individual to the nearest hospital for treatment of the individual’s illness or injury, non-emergency medical transport of an individual to another location to obtain medically needed specialized services. An air ambulance may be a specially equipped aircraft such as a helicopter or airplane. Water ambulances are specially equipped boats. Proper equipment may include ventilation and airway equipment, cardiac equipment (monitoring and defibrillation), immobilization devices, bandages, communication equipment, obstetrical kits, infection control, injury prevention equipment, vascular access equipment, and medications.
In general, an emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
Examples of medical emergencies may include illness or injury such as severe chest pains that might indicate a heart attack, slurred speech or weakness that might indicate an acute stroke, fracture, hemorrhaging, poisoning, major burns, loss of consciousness or respiratory accidents, convulsions, shock and other acute conditions.
A 2020 retrospective study by Stewart and colleagues compared the outcomes of transport between helicopter transport and ground transport for inter-facility transfer of persons with trauma to tertiary trauma centers. Looking at the records of 9880 people who had been initially seen at a non-tertiary trauma center, but were then transferred to a tertiary trauma center, the authors reported on mortality at 72 hours and within the first 2 weeks after arriving at the tertiary trauma center. For those transferred by helicopter, the mean distance between the facilities was 96.7 miles with a mean distance of 69.9 miles for those transferred by ground ambulance. The helicopter transport group showed a decreased 72 hour mortality only for the individuals transferred less than 90 miles. There were no significant differences in mortality for helicopter transport greater than 90 miles, and no significant differences in mortality at 2 weeks for either transport modality.
In 2021, Kunte and colleagues reported on whether air or ground transport led to faster delivery times in interhospital transfer and direct-from-scene transfer of individuals with ischemic stroke to a comprehensive stroke center. In this retrospective review, there were four cohorts: transfer air (n=47), transfer ground (n=68), scene air (n=40) and scene ground (n=50). Three time periods were looked at within the transport process: alarm to emergency medical services (EMS) arrival, EMS arrival to EMS departure, and EMS departure to comprehensive stroke center arrival. Median alarm to EMS arrival time was 27.5 minutes for transfer air, 15.5 minutes for transfer ground, 22 minutes for scene air, and 10 minutes for scene ground. Total on scene time was represented by EMS arrival to EMS departure. Median EMS arrival to EMS departure time was 13 minutes for transfer air, 14 minutes for transfer ground, 7.5 minutes for scene air, and 12 minutes for scene ground. In order to evaluate EMS transfer time not associated with actual travel time, the authors measured the amount of time it took EMS to respond to alarms and prepare the individual for transfer. Those in the transfer cohort had a median alarm to EMS departure of 39 minutes versus 31 minutes for those in the scene cohort. Also in the transfer cohort, transfer air had a median alarm to EMS departure of 44 minutes versus 36 minutes for transfer ground. For those being transported from the scene, scene air median alarm to EMS departure time was 37.5 minutes compared to 25 minutes for scene ground noting air transport had longer EMS time before departure compared to ground transport. Modified Rankin score was used at 90 days after treatment to quantify functional outcomes. There were no significant differences in scores between the groups. The authors did not report whether outcomes were improved. In transporting individuals either between facilities or from scenes, some variables cannot be accounted for such as weather and traffic at the time of transfer.
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2023. No new literature was identified that would prompt a change in the coverage statement.
2024 Update
Annual policy review completed with a literature search using the MEDLINE database through July 2024. No new literature was identified that would prompt a change in the coverage statement.
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CPT/HCPCS: | |
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References: |
American College of Emergency Physicians.(2018) Appropriate and Safe Utilization of Helicopter Emergency Medical Services (September 2018). Policy Statements. Available at: https://www.acep.org/globalassets/new-pdfs/policy-statements/policy-compendium.pdf. Accessed on October 5, 2021. American College of Emergency Physicians.(2018) Emergency Medical Services Interfaces with Health Care Systems (February 2018). Available at: https://www.acep.org/globalassets/new-pdfs/policy-statements/policy-compendium.pdf. Accessed on October 5, 2021. American College of Surgeons; Committee on Trauma; American College of Emergency Physicians; National Association of EMS Physicians; Pediatric Equipment Guidelines Committee; American Academy of Pediatrics.(2009) Equipment for ambulances. Bull Am Coll Surg. 2009; 94(7):23-29. Doucet J, Bulger E, Sanddal N, et al.(2013) Appropriate use of helicopter emergency medical services for transport of trauma patients: guidelines from the Emergency Medical System Subcommittee, Committee on Trauma, American College of Surgeons. J Trauma Acute Care Surg. 2013; 75(4):734-741. Funder KS, Rasmussen LS, Lohse N, et al.(2017) The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study. Scand J Trauma Resusc Emerg Med. 2017; 25(1):18. Galvagno SM Jr, Haut ER, Zafar SN, et al.(2012) Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA. 2012; 307(15):1602-1610. Kunte SA, Anderson D, Brown-Espaillat K, Froehler MT.(2021) Total transfer time for ground vs. air transport for interhospital and scene transfers of acute stroke patients. J Stroke Cerebrovasc Dis. 2021; 30(6):105704. Lyng J, Adelgais K, Alter R, et al.(2021) Recommended essential equipment for basic life support and advanced life support ground ambulances 2020: A Joint Position Statement. Prehosp Emerg Care. 2021; 25(3):451-459. Medicare Benefit Policy Manual.(2018) Chapter 10 - Ambulance Services. April 13, 2018. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c10.pdf. Accessed on October 5, 2021. Nolan B, Haas B, Tien H, et al.(2020) Causes of delay during interfacility transports of injured patients transported by air ambulance. Prehosp Emerg Care. 2020; 24(5):625-633. Palmetto GBA.(2021) Local Coverage Determination for Ambulance Services (L34549). Revised 07/29/2021. Available at: http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx. Accessed on October 5, 2021. Stewart K, Garwe T, Oluborode B, et al.(2021) Association of interfacility helicopter versus ground ambulance transport and in-hospital mortality among trauma patients. Prehosp Emerg Care. 2021; 25(5):620-628. Thomson DP, Thomas SH;(2007) 2002-2003 Air Medical Services Committee of the National Association of EMS Physicians. Guidelines for air medical dispatch. Prehosp Emerg Care. 2007 (2):265-271. |
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Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
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