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Excellus BlueCross BlueShieldCommercial · Coverage · Miscellaneous · NY · Emergency MedicineMedium impact

Ambulance: Air 11.01.06

Effective date
Mar 19, 2026
Identified
Jun 20, 2026

Summary

Excellus policy 11.01.06 considers air ambulance transport medically appropriate only to the nearest facility that can provide the appropriate care, when the individual's condition required immediate and rapid transport to minimize risk of death or deterioration that could not have been provided by land ambulance, and either the pick-up point is inaccessible by land vehicle or great distances or other obstacles would affect transport to the nearest appropriate hospital by ground. Hospital-to-hospital air transport is medically appropriate when the transfer is to a higher level of care hospital for medical services unavailable at the transferring facility and ground ambulance would endanger the individual's health, and it is considered not medically appropriate for transport to a non-acute care facility or for non-emergent transport of a stabilized individual. The 03/19/26 annual review removed emergent or urgent conditions from the policy statements.

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What to do

Action · 5 steps
01Already effective March 19, 2026: Before billing air ambulance transport, confirm the individual's condition required immediate and rapid transport to minimize risk of death or deterioration that land ambulance could not provide, and that either the pick-up point is inaccessible by land vehicle or great distances or obstacles would affect ground transport to the nearest hospital with appropriate facilities.
02For hospital-to-hospital transport, confirm the transfer is to a higher level of care hospital for medical services unavailable at the transferring facility and that ground ambulance would endanger the individual's health.
03Air ambulance services are contract specific, so check the member's subscriber contract for exclusions, distance limits and any requirement that claims be accompanied by a Pre-Hospital Care Report.
04For interfacility transfers, obtain prior authorization before the transfer where the member's contract requires it.
05Air ambulance service is ineligible for coverage if the individual is pronounced dead before the ambulance is dispatched, and benefits are not available for elective or convenience air ambulance transportation.

Codes mentioned

A0140A0430A0431A0435A0436S9960S9961T2007

Original notice

Ambulance: Air 11.01.06
excellusbcbs.com · Always check the source before changing claims.
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