WHO PAYS FOR YOUR TRIP?
	Medicare Program |  Medicaid Program |  New Jersey No Fault (PIP) |  Private Pay |
	Medicare Program Medicare is divided into two classifications Part A Covers hospital and nursing homes Part B Covers doctors, labs and ambulances Only pays for 80% of the "allowed charge" Medicare does cover the following ambulance trips Transports to and from hospitals if the receiving hospital is the closest facility (patient will be responsible for additional mileage to any other facility except when it is for an elevated level of care) Transports to approved dialysis facilities Documented emergency transports Transports between Skilled Nursing Facility(SNF) and a hospital Medicare does NOT cover Wheelchair vans or cars Transportation from one facility solely for convenience of the patient or the family Round trip transports to and from hospitals, doctor’s office, airports, non-approved dialysis centers and from a SNF to an outpatient clinic or doctor’s office Transports from one hospital to a second Physician Certification Statement (PCS) As of February 24, 1999 HCFA requires a physician statement of medical necessity for ambulance transportation Non-Emergencies are (require PCS) only considered medically necessary if the following is true: The beneficiary is unable to get up from bed without assistance The beneficiary is unable to ambulate The beneficiary is unable to sit in a chair or wheelchair There is a physician’s written order certifying that the patient must be transported in an ambulance because other means of transportation are contraindicated PCS Forms Must be signed by attending physician or PA, NP, CNS, RN or discharge planner that is employed by the hospital or facility where the patient is being treated and who has knowledge of the patient’s condition at the time of transport are required for scheduled non-emergencies (dialysis, radiation) Good for 60 days from the date it is signed A sample of a PCS Form. View/Download PCS form here(PDF file) PDF files are compatible with Adobe Acrobat version 6.0 or later. Medicare Rates Charges Ambulance Wheelchair Van Medical Car Load Charge $227.29 NOT PAID NOT PAID Mileage $6.25 NOT PAID NOT PAID Wait Time NOT PAID NOT PAID NOT PAID Attendant NOT PAID NOT PAID NOT PAID O2 $8.16
	Medicaid Program    back to top Medicaid does cover Ambulance Transports From hospital to doctor’s office, nursing home, residence, and to another hospital From SNF to home and another SNF Discharges from hospital to home or SNF Wheelchair Van Transports (MAV - Mobility Assistance Vehicles) for wheelchair bound patients and ambulatory patients needing assistance From nursing home to doctor’s office, hospital, wound care and to dialysis From home to doctor, hospital, wound care and SNF Medicaid does NOT cover transports When alternate forms of transportation (such as taxi, bus or other public conveyance) can be used In most cases, ambulatory patients are not entitled to wheelchair van transports Services are not covered for cystic fibrosis patients or residents of a NJ veterans home Medicaid Rates Charges Ambulance Wheelchair Van Medical Car Load Charge $58.00 $25.00 NOT PAID Mileage $2.50 $2.50 NOT PAID O2 $12.00
	New Jersey No Fault (PIP)    back to top If you have been involved in a motor vehicle accident in the state of NJ, your auto insurance carrier may provide for transportation in the event it is medically necessary. In these instances, the No Fault or the PIP Fee schedule is utilized. May carry a copay or deductible Reimbursed for transportation to and from medical appointments Ambulance Wheelchair Van Car PIP Fee Schedule Charges Ambulance Wheelchair Van Medical Car Load Charge $142.34 Both wheelchair van and medical car services are covered, but rates are negotiated for each transport Mileage $5.72 Wait Time NOT PAID Attendant NOT PAID O2 $35.00
	Private Pay    back to top On Time accepts cash, checks and all major credit cards.