Medical Policy: 10.01.17
Original Effective Date: June 2012
Reviewed: March 2018
Revised: December 2017
Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.
Aeromedical transport services utilizing specially designed and equipped airplanes or helicopters are important in providing rapid emergency medical care and transport of ill or injured patients. These air medical services may be involved in a primary response (transporting a patient from the scene to a nearby receiving facility) or a secondary response (interfacility transport due to the patient's need for a higher level of care).
Prior approval is required.
*Emergent medical care would be considered medically necessary services for an illness or injury that would result in further disability or death if professional attention is not delivered immediately.
If the air transportation does not meet this definition of emergent care, then the air transportation services would be considered as non-emergent.
Professional emergency air ambulance transportation services may be considered a covered benefit when ALL of the following are met:
Professional non-emergency air ambulance transportation services for an interfacility transport from a facility capable of treating an individual performed primarily for the convenience of the patient or patient’s family, physician or other health care provider would be considered a non-covered benefit.
Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc. They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.
*CPT® is a registered trademark of the American Medical Association.