Ambulance services include emergency and non-emergency ambulance services.
Eligible providers must be licensed as a transportation service provider for advanced life support, basic life support, or scheduled life support.
Provider Type Home Page Links
Eligible recipients for emergency and non-emergency transportation are as follows:
MHCP covers ambulance services when the recipient’s transportation is for the following:
MHCP covers ambulance no-load transportation only if the ambulance transportation staff provided medically necessary treatment to the recipient at the pickup point.
MHCP covers air ambulance when the following criteria are met:
All air ambulance transportation originating outside of or going to a destination outside of Minnesota or its local trade area must receive authorization from the MHCP medical review agent. The Minnesota local trade area includes Minnesota and the counties of neighboring states that are contiguous with Minnesota.
The conditions as indicated by the ICD CM codes are not in and of themselves a justification for payment. This list is not all-inclusive:
If medical necessity is not proven and proper documentation does not exist, air ambulance transportation for a recipient not having a potentially life-threatening condition will be denied and must be resubmitted as ground ambulance transportation.
MHCP covers ground ambulance when the following criteria are met:
Refer to the Transportation Services Overview page for noncovered services.
Refer to the Authorization section for general authorization requirements.
Ambulance Transportation Authorization Requirements
Type of transportation
All air ambulance transportation originating outside of Minnesota and its local trade area or going to a destination outside of Minnesota and its local trade area must receive authorization from the MHCP medical review agent. This requirement does not include to destinations or facilities located in neighboring states when the county of the neighboring state is contiguous to Minnesota.
Nonemergency ambulance trips
Request authorization from the MHCP/DHS medical review agent for nonemergency ambulance transports for recipients who will be transported for more than six one-way trips (three round trips) during a calendar month.
All air ambulance transportation originating outside of Minnesota or going to a destination outside of Minnesota must receive authorization from the MHCP medical review agent.
Request authorization from the MHCP medical review agent for nonemergency ambulance transports for recipients who will be transported for more than six one-way trips (three round trips) during a single calendar month.
Include the appropriate mileage code and total miles when requesting authorization for air or nonemergency transports.
Use the following information when billing for ambulance transportation services:
Submit the Air Ambulance Checklist (DHS-5208) (PDF) with all claims for air ambulance transports. If medical necessity is not proven and proper documentation does not exist, air ambulance transportation will be denied and must be billed as ground transportation.
Submit the Ground Ambulance Billing Checklist (DHS-5208a) (PDF) information with ground ambulance claims when the “Origin” and “Destination” indicators (modifier) indicate the transport is from and to any of the following:
Also note the following when billing for ground ambulance transport:
Ambulance Service: The transport of a recipient whose medical condition or diagnosis requires medically necessary services before and during transport.
Neonatal intensive-care unit (NICU): A unit of a hospital specializing in the care of ill or premature newborn infants.
Minnesota Statutes 144E.10 – Ambulance Service Licensing
Minnesota Statutes 144E.16 – Rules; Local Standards
Minnesota Statutes 174 – Department of Transportation
Minnesota Statutes 256B.0625, subd.17 – Transportation costs
Minnesota Statutes 256B.0625, subd. 17a – Payment for ambulance services
Minnesota Statutes 256B.0625, subd.18 – Access to medical services
Minnesota Rules 8840.5925 – Vehicle Equipment
Minnesota Rules 9505.0315 – Medical Transportation
Minnesota Rules 9505.0445 – Payment Rates
42 CFR 431.53
42 CFR 440.170 (a)