Transcription of Ambulance Services – Commercial Coverage Determination ...
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Ambulance Services – Commercial Coverage Determination ...
Ambulance Services Page 1 of 7 UnitedHealthcare Commercial Coverage Determination Guideline Effective 08/01/2020 Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services , Inc. UnitedHealthcare Commercial Cover a ge Deter mina tion Guideline Ambulance Services Guideline Number: Effective Date: August 1, 2020 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 3 Definitions .. 3 Applicable Codes .. 4 References .. 6 Guideline History/Revision Information .. 6 Instructions for Use .. 6 Coverage Rationale Indications for Coverage Air Ambulance As a general guideline, when it would take a ground Ambulance 30-60 minutes or more to transport a member whose medical condition at the time of pick-up required immediate and rapid transport due to the nature and/or severity of the member s illness/injury, air transportatio
Ambulance transportation to a home, residential, domiciliary or custodial facility is not covered. Ambulance transportation that violates the notification criteria listed in the Indications for Coverage section above. Ambulance transportation for member convenience or other miscellaneous reasons for member and/or family.
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