TL;DR
Chapter 10 of the Medicare Benefit Policy Manual sets the conditions under which Medicare covers ambulance transport. It covers the vehicle and crew requirements for basic and advanced life support, the medical necessity rule that other means of transport must be contraindicated, the definition of bed-confinement, the destinations Medicare pays for, the additional criteria for air ambulance, and the link to the ambulance fee schedule.
Chapter 10 at a glance
- Current revision
- Rev. 13459
- Issued November 26, 2025
- Effective
- July 17, 2025
- Implemented January 1, 2025
- Sections
- 44
- 3 top-level sections
- Transmittals in history
- 14
- Listed at the end of the chapter
- Monthly searches
- 50
- Google Ads, US, October 2026
What chapter 10 governs for billing
Section 10.1 sets the supplier side: the vehicle must be specially designed and equipped for transporting the sick or injured, and the crew must meet the staffing requirements for basic or advanced life support. Section 10.2 sets the patient side. Ambulance transport is covered only when other means of transport would endanger the beneficiary's health, whether or not other transport is actually available, and the trip must be reasonable for the patient's condition. Section 10.2.3 explains bed-confinement: unable to get up from bed without help, unable to walk and unable to sit in a chair or wheelchair. Bed-confinement is one factor, not a test that decides coverage by itself.
Section 10.3 covers destinations. Covered trips include transport to the nearest appropriate facility that can treat the patient, between institutions when the first cannot provide needed care, and from an institution to the beneficiary's home, with separate rules for trips that are part of a packaged institutional service and for patients who are not inpatients. Section 10.4 adds the air ambulance criteria: the patient's condition must require immediate and rapid transport that a ground ambulance could not provide, and either the pickup point is inaccessible by ground or great distances or other obstacles stand between the patient and the nearest appropriate hospital; payment is limited when ground transport would have sufficed.
Section 20 covers claim-level coverage guidelines, including mandatory assignment for ambulance services and the beneficiary signature requirement with its exceptions, and section 30 defines the ground and air services paid under the ambulance fee schedule. The payment and billing details, such as levels of service, mileage and the inflation factor, are in chapter 15 of the Claims Processing Manual.
Sections billing teams use most
Section numbers and headings are CMS's; the notes are ours. Each section number opens the official chapter 10 PDF at the page where that section starts.
| Section | CMS heading | Why it matters |
|---|---|---|
| 10.1.2 | Vehicle Requirements for Basic Life Support and Advanced Life Support | Vehicle requirements for basic and advanced life support. |
| 10.2.1 | Necessity for the Service | Necessity for the service: other means of transport contraindicated. |
| 10.2.3 | Medicare Policy Concerning Bed-Confinement | Medicare's definition of bed-confinement and how it is used. |
| 10.3.6 | Appropriate Facilities | Appropriate facilities and the nearest-facility rule. |
| 10.4.1 | Coverage Requirements | Air ambulance coverage requirements. |
| 20.1.2 | Beneficiary Signature Requirements | Beneficiary signature requirements and exceptions for ambulance claims. |
How chapter 10 shows up on claims and denials
Most ambulance denials say the transport was not medically necessary, reason code 50, because the trip report does not show why the patient could not travel safely by other means. Denials also follow when the destination is not a covered one, such as a trip home that does not start at an institution, or when a trip to a farther facility is billed without showing that nearer ones could not treat the patient.
The medical necessity case is made in the run report, not on the claim. The patient's condition at pickup, the need for monitoring or restraint, and why a wheelchair van or car was unsafe should all be recorded; for non-emergency scheduled trips the physician certification must agree. Billing and coding errors are handled under chapter 15 of the Claims Processing Manual.
Codes you are likely to see on the remittance when a claim runs into this chapter's rules. The code pages explain each code's meaning, root causes and the usual fix.
| Code | Type | When it appears |
|---|---|---|
| 50 | Claim adjustment reason code | Transport not medically necessary; other means of transport not contraindicated. |
| 272 | Claim adjustment reason code | Coverage guidelines not met, such as a non-covered destination. |
| 16 | Claim adjustment reason code | Missing information needed to decide coverage, such as origin and destination. |
Current revision and recent transmittals
The chapter PDF posted on cms.gov is current through Rev. 13459, issued November 26, 2025, effective July 17, 2025, implemented January 1, 2025 (change request 14036). That revision changed section 30.1.1 (Ground Ambulance Services). Its subject line reads: “Update to the List of Advanced Life Support, Level 2 (ALS2) Procedures in Chapter 10, Ambulance Services, Section 30.1.1, Definition of Ground Ambulance Services”.
The newest rows of the transmittal history printed at the end of the chapter (14 revisions in all). Rows whose subject could not be read reliably from the PDF table are left out; the PDF has the complete list.
| Revision | Issued | Subject | CR |
|---|---|---|---|
| R13459BP | November 26, 2025 | Update to the List of Advanced Life Support, Level 2 (ALS2) Procedures in Chapter 10, Ambulance Services, Section 30.1.1, Definition of Ground Ambulance Services | 14036 |
| R243BP | April 13, 2018 | Ambulance Transportation for a Skilled Nursing Facility (SNF) Resident in a Stay Not Covered by Part A - Medicare Benefit Policy Manual, Chapter 10 and Medicare Claims Processing Manual, Chapter 15 | 10550 |
| R236BP | June 17, 2017 | Medicare Benefit Policy Manual - Chapter 10, Ambulance Locality and Advanced Life Support (ALS) Assessment | 10110 |
| R225BP | September 9, 2016 | Ambulance Staffing Requirements | 9761 |
| R190BP | July 11, 2014 | Beneficiary Signature Requirements for Ambulance Services | 8760 |
| R187BP | May 1, 2014 | Update to the Medicare Benefit Policy Manual to Restore Missing Air Ambulance Definitions | 8706 |
Sections ordered by the date in the revision note printed under each heading.
| Section | Heading | Revision |
|---|---|---|
| 30.1.1 | Ground Ambulance Services | Rev. 13459, November 26, 2025; effective July 17, 2025 |
| 10.3 | The Destination | Rev. 243, April 13, 2018; effective July 16, 2018 |
| 10.3.3 | Separately Payable Ambulance Transport Under Part B versus Patient Transportation that is Covered Under a Packaged Institutional Service | Rev. 243, April 13, 2018; effective July 16, 2018 |
| 10.3.5 | Locality | Rev. 236, June 16, 2017; effective September 18, 2017 |
| 10.1.2 | Vehicle Requirements for Basic Life Support and Advanced Life Support | Rev. 226, September 12, 2016; effective January 1, 2016 |
| 30.1 | Definition of Ambulance Services | Rev. 226, September 12, 2016; effective January 1, 2016 |
| 20.1.2 | Beneficiary Signature Requirements | Rev. 190, July 11, 2014; effective August 12, 2014 |
| 30.1.2 | Air Ambulance Services | Rev. 187, May 1, 2014; effective August 4, 2014 |
Section index
Every section in the chapter's table of contents, grouped under its top-level heading, with the PDF page where it starts. Open a heading to see its subsections.
10 Ambulance Service · p. 3 · 35 subsections
- Open section 10 in the PDF
- 10.1 Vehicle and Crew Requirement · p. 3
- 10.1.1 The Vehicle · p. 3
- 10.1.2 Vehicle Requirements for Basic Life Support and Advanced Life Support · p. 3
- 10.1.3 Verification of Compliance · p. 4
- 10.1.4 Ambulance Services Furnished by Providers of Services
- 10.1.5 Equipment and Supplies · p. 5
- 10.2 Necessity and Reasonableness · p. 5
- 10.2.1 Necessity for the Service · p. 5
- 10.2.2 Reasonableness of the Ambulance Trip · p. 6
- 10.2.3 Medicare Policy Concerning Bed-Confinement · p. 6
- 10.2.4 Documentation Requirements
- 10.2.5 Transport of Persons Other Than the Beneficiary
- 10.2.6 Effect of Beneficiary Death on Medicare Payment for Ground Ambulance Transports · p. 7
- 10.3 The Destination · p. 7
- 10.3.1 Institution to Beneficiary's Home · p. 8
- 10.3.2 Institution to Institution · p. 9
- 10.3.3 Separately Payable Ambulance Transport Under Part B versus Patient Transportation that is Covered Under a Packaged Institutional Service · p. 9
- 10.3.4 Transports to and from Medical Services for Beneficiaries who are not Inpatients · p. 11
- 10.3.5 Locality · p. 11
- 10.3.6 Appropriate Facilities · p. 12
- 10.3.7 Partial Payment · p. 12
- 10.3.8 Ambulance Service to Physician's Office · p. 13
- 10.3.9 Transportation Requested by Home Health Agency · p. 13
- 10.3.10 Multiple Patient Ambulance Transport · p. 13
- 10.4 Air Ambulance Services · p. 14
- 10.4.1 Coverage Requirements · p. 14
- 10.4.2 Medical Reasonableness · p. 15
- 10.4.3 Time Needed for Ground Transport · p. 16
- 10.4.4 Hospital to Hospital Transport · p. 16
- 10.4.5 Special Coverage Rule · p. 16
- 10.4.6 Special Payment Limitations · p. 16
- 10.4.7 Documentation · p. 17
- 10.4.8 Air Ambulance Transports Canceled Due to Weather or Other Circumstances Beyond the Pilot's Control · p. 17
- 10.4.9 Effect of Beneficiary Death on Program Payment for Air Ambulance Transports · p. 17
- 10.5 Joint Responses · p. 19
20 Coverage Guidelines for Ambulance Service Claims · p. 20 · 3 subsections
- Open section 20 in the PDF
- 20.1 Mandatory Assignment Requirements · p. 23
- 20.1.1 Managed Care Providers/Suppliers · p. 23
- 20.1.2 Beneficiary Signature Requirements · p. 23
30 Implementation of the Ambulance Fee Schedule · p. 24 · 3 subsections
- Open section 30 in the PDF
- 30.1 Definition of Ambulance Services · p. 25
- 30.1.1 Ground Ambulance Services · p. 25
- 30.1.2 Air Ambulance Services · p. 31
Using this chapter in a denial or appeal
Start with the remittance. The claim adjustment reason code says what happened to the line, the remark code narrows it, and the group code says who is liable. Match that to the section of the chapter that sets the rule, then read the section in the official PDF rather than a summary: the wording that matters, such as a time limit, a modifier requirement or a documentation element, is usually a single sentence. Check the revision note under the section heading, because a rule that changed after the date of service may not apply to the claim, and an effective date earlier than the issue date can make a new rule reach back.
When the chapter supports the claim, cite it precisely in the redetermination request: the publication number, chapter, section and revision. When it does not, the fix is usually a corrected claim or better documentation rather than an appeal, and a coding or format rejection is corrected and resubmitted because it carries no appeal rights. Manual instructions bind the Medicare Administrative Contractor, so they settle most first-level disputes; at the hearing level, administrative law judges give them substantial deference without being bound by them. If the issue turns on whether a service is covered at all, read the matching Benefit Policy Manual chapter and any national coverage determination or local coverage determination as well, because coverage and billing rules are written in different places.
How QuickIntell works with Benefit Policy Manual chapter 10
QuickAuth coordinates requirement checks, documentation, submission and status tracking with human review, so the coverage conditions in this chapter are looked at before the service. QuickRCM handles claim readiness and the coverage denials that follow.
Frequently asked questions: chapter 10
How does Medicare define bed-confined?
Chapter 10 section 10.2.3 defines a bed-confined beneficiary as unable to get up from bed without assistance, unable to ambulate and unable to sit in a chair or wheelchair. It is one factor in medical necessity, not a test that decides coverage on its own.
When does Medicare cover an air ambulance?
Under section 10.4.1, when the patient's condition requires immediate and rapid transport that a ground ambulance could not provide, and either the pickup point is inaccessible by ground or great distances or other obstacles stand in the way of reaching the nearest appropriate hospital.
Where are ambulance payment rules?
Coverage is in chapter 10 of the Benefit Policy Manual; payment and billing, including levels of service and mileage, are in chapter 15 of the Claims Processing Manual.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Benefit Policy Manual, Chapter 10: Ambulance ServicesVersion Rev. 13459, issued 2025-11-26 · effective 2025-07-17 · file bp102c10.pdfSHA-256 60e7b343053dc5a9…
- Medicare Benefit Policy Manual (Pub. 100-02)Version 17 chapter PDFs; newest revision Rev. 13889 (chapter 15), issued 2026-07-30 · effective 2026-09-27 · file 100-02-benefit-policy-manual/*.pdf (17 chapters; SHA-256 of their sha256sum listing)SHA-256 be35772e4f9f80b4…
Disclaimer
This guide summarizes a CMS manual chapter in our own words for billing teams; section headings and transmittal subjects are quoted from the chapter PDF. The chapter itself is the authority, and it changes by transmittal. Not legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.