Does S9960 require prior authorization?

No, S9960 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S9960?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S9960`, Ambulance service, conventional air service, nonemergency transport, one way

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Providers must reference the most up-to-date professional coding guidance prior to claim submission.
Clinical documentation demonstrating that ground transport would endanger the patient (vital signs, mechanism of injury, clinical findings)

Documentation required: evidence that the member’s medical condition required immediate and rapid ambulance transportation that could not have been provided by ground ambulance; location of pick-up and drop-off; level of care of the receiving and transferring facilities; and all additional documentation supporting the need for air ambulance services (e.g., accessibility, distances, obstacles).

Key Coverage Criteria

The individualâs condition must be such that any form of transportation other than by ambulance would be medically contraindicated;and
The ambulance must have the necessary equipment and supplies to address the needs of the individual;and
The use of air and water ambulance services is consideredmedically necessarywhenallthe following criteria are met:
Transportation to thenearest* appropriate facility for treatment of an individualâs illness or injury when either of the following circumstances exists:Scene of an accident or emergency when there is a medical condition that is life-threatening or first responders (for example, law enforcement officers, emergency medical services members, or fire services members) deem to be life-threatening;orFrom one facility to another when the first facility does not have the required services to treat the [...]
Scene of an accident or emergency when there is a medical condition that is life-threatening or first responders (for example, law enforcement officers, emergency medical services members, or fire services members) deem to be life-threatening;or
From one facility to another when the first facility does not have the required services to treat the individual;and

7 Active Policies

ANTHEM-CG-ANC-04, Ambulance Services: Air and Water

AMBETTER-CP.MP.175, Air Ambulance

BCBSIL-MED201.058, Ambulance and Transport Services

BCBSMT-MED201.058, Ambulance and Transport Services

BCBSNM-MED201.058, Ambulance and Transport Services

BCBSOK-MED201.058, Ambulance and Transport Services

REGENCE-UM13, Air Ambulance Transport

`S9960`, Ambulance service, conventional air service, nonemergency transport, one way

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

S9960, Ambulance service, conventional air service, nonemergency transport, one way

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

7 Active Policies

Related Codes

Have a follow-up question?

`S9960`, Ambulance service, conventional air service, nonemergency transport, one way