CMS implemented several changes affecting ground ambulance and EMS billing in 2026. These affect how non-emergency medical transports are documented, which transports require prior authorization, and how ambulance suppliers report cost data.
Prior authorization for non-emergency ambulance transport
CMS expanded the prior authorization requirement for repetitive non-emergency ambulance transports (RNEATs). A transport is “repetitive” if the same beneficiary requires three or more transports within a 10-day period or at least once per week for three or more consecutive weeks.
Prior authorization must be obtained from the beneficiary’s Medicare Administrative Contractor (MAC) before the third repetitive transport. Failure to obtain prior authorization doesn’t automatically deny payment, but triggers a post-payment review that frequently results in denials.
Documentation required for prior authorization:
- Physician certification statement (PCS) signed within 90 days of the first transport
- Documentation of the beneficiary’s medical condition preventing transport by other means
- The origin and destination of transport
Non-emergency medical transport documentation
For all non-emergency transports (Level B and above), medical necessity must be documented in the patient care report (PCR). The documentation must establish that:
- The beneficiary is bed-confined or cannot be safely transported by other means
- The transport is to the nearest appropriate facility
- The receiving facility can provide the required level of care
⚠️ Risk flag: “Ambulance-only” documentation no longer satisfies MACs in most jurisdictions. The beneficiary’s medical record — not just the PCR — must support medical necessity. Obtain records from the referring facility before billing.
Ground Ambulance Data Collection System (GADCS)
CMS requires ground ambulance suppliers to submit cost and utilization data under the GADCS program. Suppliers selected for data collection receive notification from CMS and must submit data within the designated period.
Non-compliance with GADCS reporting results in a 10% payment reduction for all Medicare ambulance claims in the following year.
Supplier number and enrollment requirements
Ambulance suppliers must maintain active enrollment under the CMS-855B. Changes in ownership, service area, or vehicle additions require filing an update or a new enrollment application. Failure to update enrollment when required is an overpayment risk.
Ask Mae if you have questions about a specific EMS billing or enrollment issue.