Applies to TVA members only.
DESCRIPTION
This policy provides guidelines that are appropriate for the majority of individuals who need one-way ambulance transport greater than 100 miles in both emergency and non-emergency situations. Unique clinical circumstances may justify individual consideration for coverage based on a review of applicable medical records.
GUIDELINE
The use of ground medical transport greater than 100 miles is considered medically appropriate when the individual is transported to the nearest hospital with the appropriate level of services for the treatment of the individual’s illness or injury (including, but not limited to the following):
Emergent care for individuals living in rural areas
Specialized medical services
Examples of specialized medical services that may not be available at all hospitals or acute care facilities include, but are not limited to:
Burn care
Cardiac care
Critical care
Trauma care
Organ transplantation (The patient must be transported to the approved transplant facility)
Non-emergent transport from one hospital or medical facility to another hospital or medical facility
The individual is unable to be transferred by any other method (for example, confined to bed, presence of a condition that only allows transport by stretcher)
Examples of non-emergent ambulance transport include, but are not limited to:
From acute care to a skilled nursing facility
From acute care to a rehabilitation facility
ORIGINAL EFFECTIVE DATE: 5/26/2017
MOST RECENT REVIEW DATE: 5/26/2017
ID_THM_TVA_UM
This document has been classified as public information.