TRICARE covers the following ambulance services:
- Emergency transport to a hospital
- Transfer from one hospital to another hospital more capable of providing the required care as ordered by a physician
- Transfers from an emergency room to a hospital more capable of providing the required care
- Transfers between a hospital or skilled nursing facility and another facility for outpatient therapy or diagnostic services ordered by a physician
- Transfers to and from a skilled nursing facility* when medically indicated
*Payment of ambulance transfers to and from a skilled nursing facility may be included in the Skilled Nursing Facility Prospective Payment System (SNF PPS).
Note: Transports or transfers must be to the closest facility capable of providing the required care, except when transporting or transferring to a military treatment facility.
Air Ambulance or Boat Ambulance
Air ambulance or boat ambulance transport is only covered when the pickup point is not accessible by a land vehicle, or when great distance or other obstacles are involved in transporting the patient to the nearest hospital with appropriate facilities. The patient’s medical condition must require a speedy admission or indicate they are not able to be transferred by other means.
Paramedic Intercept and Joint Response
Paramedic intercept services may be covered separate from ambulance transport when the patient’s medical condition requires advanced life support (ALS) services such as EKG monitoring, chest decompression or intravenous (IV) therapy that cannot be provided by basic life support (BLS) ambulance paramedics. Visit our Ambulance Joint Response/Treat-and-Release Reimbursement page to learn more about reimbursement when a basic life support (BLS) ambulance provides the transport of a TRICARE beneficiary and an advanced life support (ALS) paramedic provides medically necessary services.
Professional Services Without Transport
TRICARE covers treat-and-release services from TRICARE-authorized providers, under the following conditions:
- The services are medically necessary.
- Failure to provide a hospital transport was because transport was no longer required or the patient refused transport after receiving services.
- The ambulance provider bills using code A0998. The reimbursement rate will match Medicare’s rate for code A0428 (BLS non-emergency).
Visit our Ambulance Joint Response/Treat-and-Release Reimbursement page for more information.
Services Not Covered
- Vehicles that provide passenger transport to and from medical appointments (for example, medicabs, ambicabs or paratransit)
- Ambulance service used instead of taxi service when the patient’s condition would have permitted use of regular private transportation
- Transport or transfer of a patient primarily for the purpose of having the patient closer to home, family, friends or personal physician (with no medical need for the transport)
- Ambulance services related to a condition not covered by TRICARE, such as complications from elective plastic surgery