Transcription of Effective Date: January 1, 2019
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Effective Date: January 1, 2019
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 transportation may be appropriate.
Ambulance Services Page 4 of 6 UnitedHealthcare Commercial Coverage Determination Guideline Effective 01/01/2019 Proprietary Information of UnitedHealthcare.
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