Updated: January 2026
Purpose
ND Medicaid covers services provided by ambulance providers that are licensed and enrolled with ND Medicaid.
Emergency transport by ambulance is a covered service. Nonemergency transport by ambulance is a covered service only when medically necessary and authorized by a transportation specialist.
Applicability
Eligible Providers
To receive payment from ND Medicaid, the eligible servicing and billing providers must be enrolled with ND Medicaid on the date of service, and their National Provider Identifiers (NPIs) must be active in their Medicaid enrollment records. Servicing providers acting as a locum tenens provider must be enrolled with ND Medicaid, and services they provide must be billed with their NPI. Please refer to provider enrollment for additional details on enrollment eligibility and supporting documentation requirements.
Ambulance services can be provided by the following enrolled providers as allowed by their scope of their licensure:
- Ground Ambulance providers; and
- Air ambulance providers.
Eligible Members
Providers are responsible for verifying a member’s eligibility before providing services. Eligibility can be verified using the ND Medicaid MMIS Portal or through the through the Automated Voice Response System by dialing 1.877.328.7098.
Refer to the Member Eligibility Manual for additional information regarding eligibility including information regarding limited coverage categories.
Covered Services and Limits
General Provider Policies
The General Provider Policies details basic coverage requirements for all services. Basic coverage requirements include:
- The provider must be enrolled in ND Medicaid;
- Services must be medically necessary;
- The member must be eligible on the date of service; and
- If applicable, the service has an approved service authorization.
The Procedure Code Look-up Tool can be used to identify if a procedure code is covered by ND Medicaid along with code specific details such as ORP requirements, Service Authorization requirements, and current rates.
The member must receive medically necessary services before and/or during transport and the transportation must comply with the following conditions:
- The ambulance provider must be licensed per state requirements;
- The member’s transportation must be in response to a 911 emergency call, a police or fire department call, or an emergency call received by the provider; and
- Out-of-state ambulance transport for emergency and nonemergency medical services, including follow up visits, may be reimbursed only if the out of state medical services are approved by ND Medicaid and the member’s medical condition substantiates transportation by ambulance.
Air Ambulance
Transportation by air ambulance is a covered Medicaid service if the member has a potentially life-threatening medical condition that prevents the use of another form of transportation. Claims submitted for air ambulance transport must include documentation of medical necessity, including the need for air transport.
For out of state air ambulance transport, the transferring facility must follow criteria for emergency out of state transportation. Air ambulance transportation originating outside of North Dakota or to a destination outside of North Dakota, must inform ND Medicaid within 48 hours of the transfer. Documentation to ND Medicaid must include:
- Destination and date of transfer;
- Mode of transportation;
- Discharge summary; and
- If trip is less than 50 miles, the facility must verify why air rather than ground ambulance was used.
Transportation Between Providers
Ambulance transportation of a member between providers is covered when medically necessary in these situations:
- Transportation between two (2) long-term care facilities when the member’s plan of care requires a health service not available at the long-term care facility where the member resides;
- Transportation between two (2) hospitals when a necessary service is not available at the hospital where the member is located when medical necessity is determined; and
- Transportation between a hospital and long-term care facility.
Limits
A member’s death is recognized when pronounced by a legally authorized individual in the state where the pronouncement is made.
Consistent with Medicare payment guidelines, if a member is pronounced dead after the ambulance is called but before the ambulance arrives at the scene, payment will be based on:
- Basic life support (BLS) level of service base rate only, for a ground vehicle; and
- Fixed wing or rotary wing base rate only, as appropriate, for an air ambulance.
If air transport was provided and it was not medically necessary for air transport, the charges will be reimbursed at a ground ambulance rate as long as the services at the receiving facility are approved.
Service Authorization Requirements
Air transport from an out of state facility back to a North Dakota facility requires prior authorization from the Out of State Program.
Noncovered Services
General Noncovered Services
The Noncovered Services Policy contains a general list of services that are not covered by North Dakota Medicaid.
Noncovered ambulance services include:
- Unloaded miles without a member on board;
- Transportation of a member to a hospital or other health care services ordered by a court or law enforcement agency - except when transportation via ambulance is medically necessary; or
- Transportation of a member pronounced dead prior to the time the ambulance was called or dispatched.
Documentation Requirements
General Requirements
Providers must keep legible medical and financial records that fully justify and disclose the extent of services provided and billed to ND Medicaid. Records must be retained for at least 7 years after the last date the claim was paid or denied. Providers must follow the documentation requirements in the Provider Requirements Policy.
Reimbursement Methodology and Claim Instructions
Timely Filing
ND Medicaid must receive an original Medicaid primary claim within one hundred eighty (180) days from the date of service. The time limit may be waived or extended by ND Medicaid in certain circumstances. The Timely Filing Policy contains additional information.
Third-Party Liability
Medicaid members may have one or more additional source of coverage for health services. ND Medicaid is generally the payer of last resort. Providers must pursue the availability of third-party payment sources. The Third Party Liability Policy contains additional information.
Client Share (Recipient Liability)
Client share (recipient liability) is the monthly amount a member must pay toward the cost of medical services before the Medicaid program will pay for services received. The Client Share Policy contains additional information.
Reimbursement
A claim for services must be submitted at the provider’s usual and customary charge. Payment for services is limited to the lesser of the provider’s usual and customary charge or the ND Medicaid calculated reimbursement.
Multiple patients on one trip
Ambulance providers submitting a claim using the 837P HIPAA compliant X12 format or the CMS-1500 paper form for an ambulance transport with more than one patient onboard must use the “GM” modifier (“Multiple Patients on One Ambulance Trip”) for each service line item. In addition, ambulance providers are required to submit documentation to specify the particulars of a multiple patient transport. The documentation must include the total number of patients transported in the vehicle at the same time and the Medicaid recipient identifiers for each Medicaid recipient.
If two patients are transported to the same destination simultaneously, for each Medicaid member, Medicaid will allow 75 percent of the payment allowance for the base rate applicable to the level of care furnished to that member plus 50 percent of the total mileage payment allowance for the entire trip. If three or more patients are transported to the same destination simultaneously, then the payment allowance for the Medicaid member (or each of them) is equal to 60 percent of the base rate applicable to the level of care furnished to the beneficiary. However, a single payment allowance for mileage will be prorated by the number of patients onboard. This policy applies to both ground and air transports.
Modifiers
ND Medicaid requires that the ambulance supplier report a two-digit modifier for each ambulance trip. The first digit of the modifier indicates the origin of the trip, and the second digit indicates the destination. Some examples of ambulance modifiers include:
- D: Diagnostic or therapeutic site other than P or H
- E: Residential, domiciliary, or custodial facility
- G: Hospital-based ESRD facility
- H: Hospital
- I: Site of transfer, such as an airport or helicopter pad
- J: Freestanding ESRD facility
- N: Skilled nursing facility
- P: Physician's office
- R: Residence
- S: Scene of accident or acute event
- X: Intermediate stop at physician's office on way to hospital
When a member has two identical ambulance trips on the same calendar date, append modifier -76 to the second trip.
Date of Service
The date of service on the claim should be when the ambulance departs the point of pickup with the member on board.
Claim Form
Ambulance services must be billed using the CMS 1500 claim form or 837p.Detailed claim instructions are available on the ND Medicaid Provider Guidelines, Policies & Manual webpage.
Definitions
Loaded Transportation – number of miles that a member is transported in the ambulance.
References
Related Policies
Contact
Medical Services
600 East Boulevard Ave
Bismarck, ND 58505-0250
Phone: (701) 328-2310
Email: dhsmedicalservices@nd.gov
Policy Updates
August 2025
- Coverage Limitations
- Removed requirement for emergent services to only be covered when taking a member to an ND Medicaid covered provider or service.
January 2026
- Format changes throughout the document.