Ground ambulance transportation coverage under Apple Health managed care

Provider Alert!

Clarification of ground ambulance transportation coverage under Apple Health managed care

Emergency ambulance transportation is covered under Apple Health managed care, including for psychotic episodes that require ambulance transportation of a mentally-ill client to an evaluation and treatment facility.

Nonemergency ground ambulance services are covered when they are:

• Necessary to transport an enrollee between facilities to receive a contracted service;
• Necessary to transport an enrollee who must be carried on a stretcher, or who may require medical attention en route to receive a covered service; or
• Effective for claims with dates of service on and after April 1, 2016, medically necessary to transport an enrollee from home to a facility for a medical appointment (e.g., ventilator dependent, bed-confined and unable to hold self-upright or unsafe for wheelchair transport).