Medicare regulations provide some interpretative guidance as to what might be reasonably related.
“After an injury or disability”
Medicare prohibits transportation benefits unless the need for transportation relates to Medicare-covered services. It’s one thing to have an air ambulance take a worker to a trauma one center. It is quite another thing to ask a helicopter to drop a worker off at his house. There is an actual federal regulation on this point. Ground transportation may be a reasonable alternative if the distance to the appropriate medical facility is close.
Medicare prohibits transportation benefits beyond the nearest “appropriate” facility. This is clearly defined in Chapter 10.3 of the Medicare Benefit Policy Manual that “transport is covered to the nearest appropriate facility to obtain necessary diagnostic and or therapeutic services.” Transportation to a more remote facility does not flow from medical necessity.
Can fee resolution resolve a $30,000 helicopter bill?
Section 4531 (b) (2) of the Balanced Budget Act (BBA) of 1997 added a new section 1834 (l) to the Social Security Act which mandated the implementation of a national fee schedule for ambulance services.
Fee schedule under Medicare for fixed and rotary wing ambulance