On November 16, 2015, the Centers for Medicare & Medicaid Services (CMS) published the Final 2016 Physician Fee Schedule Rule in the Federal Register.  The Final Rule contains several notable ambulance-specific provisions that impact billing, compliance and operations.

The primary changes in the Final Rule that impact the ambulance industry are:

1. The ambulance bonus payments were extended through December 31, 2017 and the final rule reflects that extension.  As a reminder, the bonuses are as follows:

  • 2% for ground transports originating in urban areas
  • 3% for ground transports originating in rural areas
  • 22.6% for ground transports originating in super-rural areas

2. Some ZIP code designations (i.e. urban, rural and super-rural) changed beginning January 1, 2015 and those changes are now permanent.  While less than 5% of all ZIP codes were changed, any change is significant as it impacts reimbursement.  For the latest information from CMS, and a state-by-state list of ZIP codes that changed, click HERE (link is external) (list of ZIP codes are located in the “Downloads” section).

3. Ambulance staffing regulations were changed in three ways that CMS believes will promote compliance and ensure consistency with Medicare regulations.  The changes modify the definition of Basic Life Support and the BLS staffing requirements.  The regulations also now state that all ambulance transports must be staffed by at least two people who meet the requirements of state and local laws where the services are being furnished.

Page Wolfberg & Wirth have published a summary of the ambulance specific provisions which can be found on the PWW website.