On December 23, 2024, CMS posted a revised version of the CY 2025 Ambulance Fee Schedule Public Use Files on its website. These files contain the Medicare allowed amounts for the various levels of ambulance service and mileage. The file is organized by state, and by payment locality within each state. The 2025 Ambulance Fee Schedule Public Use File can be viewed by clicking here.
Unfortunately, CMS has elected in recent years to release its Public Use Files without state and payment locality headings. As a result, in order to look up the rates in your service area, you would need to know the CMS contract number assigned to your state. This is not something the typical ambulance service would necessarily have on hand. For this reason, the AAA has created a reformatted version of the CMS Medicare Ambulance Fee Schedule, which includes the state and payment locality headings. Members can access this reformatted fee schedule below.
The American Ambulance Association is also pleased to announce the release of its 2025 Medicare Rate Calculator tool. The AAA believes this is a valuable tool that can assist members in budgeting for the current year. This calculator has been updated to account for recent changes in Medicare policies, including the 2025 Ambulance Inflation Factor and the extension of the temporary adjustments for ground ambulance services (i.e., 2% urban, 3% rural, and super rural bonus) through March 31, 2025. This extension was the result of Section 3203 of the American Relief Act, 2025. Barring further legislation, these temporary adjustments will expire on March 31, 2025.
Note on Medicare Sequestration: Both the Ambulance Fee Schedule Public Use Files and the AAA Medicare Rate Calculator display the current Medicare allowables. Neither takes into account the impact of so-called “budget sequestration” on Medicare payments. By law, the sequester requires Medicare contractors (and Medicare Advantage insurers) to reduce the amounts they pay under the Medicare Ambulance Fee Schedule by 2% (i.e., 2% off the 80% of the Medicare allowable typically paid by the Medicare contractor).
NHTSA is soliciting applications for appointment to the DOT’s NEMSAC. The purpose of NEMSAC is to serve as a nationally recognized council of Emergency Medical Services (EMS) representatives and consumers to provide advice and recommendations regarding EMS to DOT. Through NHTSA, NEMSAC’s advice is provided to the Federal Interagency Committee on EMS (FICEMS). Deadline: November 1, 2024
National data shows delayed EMS crews frequently wait an hour or more before returning to service
“To look at the scope and severity of wall times nationwide, InvestigateTV obtained data from the National Emergency Medical Services Information System (NEMSIS), a program run through the National Highway Traffic Safety Administration and the University of Utah that provides a standardized method of recording and reporting information about 911 calls involving EMS.
The data, which local EMS agencies report to their respective states that in turn submit it to the national database, documents all aspects of the call, including if the ambulance crew experienced any kind of delay.”
On August 22, 2024, the Department of Veterans Affairs (VA) published a notice in the Federal Register announcing an extension of the timely filing limits for claims impacted by the Change Healthcare cyberattack.
In February, Change Healthcare announced that it was the victim of a massive cyberattack. In response, Change Healthcare proactively took down several of its online platforms, including its online claim submission platform. This platform is used by the VA to receive electronic claims. The VA indicated that this resulted in what it calls “limited or no ability” to receive electronic claims between February 21, 2024 and May 8, 2024 (referred to hereinafter as the “Limited Access Period”).
The current notice is intended to address problems with timely filing that resulted from that Limited Access Period. Specifically, the VA is announcing that claims that would have been considered timely had they been submitted during the Limited Access Period will continue to be treated as timely filed to the extent they are submitted on or before October 31, 2024.
Claims submitted after that date will not be considered timely filed, and will be denied.
Thus, the VA is effectively extending the timely filing period for VA claims through October 31, 2024. The VA expressly noted that this would include claims for transportation furnished to veterans with dates of service between February 21, 2022 and March 23, 2024. Note: the specific program under which ambulance transportation claims are being paid will determine the actual timely filing limits. The VA was simply noting the earliest and latest possible qualifying dates.
Therefore, if you have claims for ambulance services that were recently denied by the VA for lack of timely filing, the AAA encourages you to resubmit those claims to the VA under this extending timely filing period.
A Message from GAPBAC Committee Member Shawn Baird
Please see below for a video message from former American Ambulance Association President Shawn Baird, who participated on the Ground Ambulance Patient and Billing Advisory Committee. A formal analysis of the complete report to Congress is forthcoming.
Video Transcript
Hello, I’m Shawn Baird, past president of the American Ambulance Association.
Together with my fellow ambulance profession representatives Ted Van Horne, Regina Crawford, and Rhonda Holden, I was privileged to speak on behalf of AAA members and the EMS profession as a whole during the deliberations of the Ground Ambulance and Patient Billing Advisory Committee, also known as GAPBAC.
Today, I’m excited to share with you the culmination of our efforts—the release of a report to Congress that could transform how ground ambulance services are reimbursed, ensuring better protection for patients against surprise medical bills as well as fair compensation for the essential mobile healthcare we deliver daily.
We know that the patient care and transport we provide every day, 24/7, is vital to the health and welfare of our communities. In many parts of the country, we are the only healthcare available within hours. I am excited that if Congress acts on these recommendations, patients can not only continue to depend on our vital care, but also be relieved of the financial stress of the unknown bill when insurance falls short of appropriate payment. Quite frankly, if adopted by Congress, these recommendations would take patients out of the middle between providers and insurers, and free us to remain focused on what we do best; taking care of patients, 24/7.
Let me rewind a bit and give you the full context for this report.
GAPBAC was formed following the American Ambulance Association’s successful advocacy efforts to carve ground ambulance services out of the No Surprises Act. Through the dedication of AAA volunteer leaders made possible by your dues investment, we were able to successfully educate legislators about the unique nature of EMS. We effectively highlighted our inability to pick and choose patients, our role as the safety net provider in rural and medically underserved urban areas, as well as our sky-high costs of readiness. Instead of rolling ambulance services into a one-size-fits-all healthcare billing scheme that wouldn’t work for EMS, legislators had the vision and foresight to create the GAPBAC committee.
The group’s charter was signed in November 2021, and the roster was announced in December 2022. We are proud that former American Ambulance Association board member Asbel Montes was selected to take the helm as Chair.
Since then, our committee, composed of patient advocates, physicians, EMS experts, government officials, and insurance industry representatives, has worked collaboratively to address a critical issue—out-of-network billing for ground ambulance patients covered by non-ERISA health plans.
This discussion presented an extraordinary challenge as ambulance services face skyrocketing costs, flat reimbursement from Medicare, and an unprecedented workforce shortage. At the same time, our patients were sometimes confused by the complex health insurance landscape including copays, deductibles, and policy limitations.
But the GAPBAC panel, with the help of experts including AAA’s own Kathy Lester, persevered. Through research, dialogue, and compromise, GAPBAC’s team members developed 14 key recommendations that, if adopted by Congress, would protect patients, financially sustain EMS, enhance transparency, and empower state and local governments to determine fair reimbursement rates for their residents.
While I urge you to read the report to Congress in its entirety, rest assured that the AAA advocacy team will soon share a concise summary with our membership.
As I mentioned, the release of this report has been no small task. The collaboration across various stakeholder groups was unprecedented in EMS history, and every voice brought valuable insights, driving us toward solutions that consider all perspectives on the complex mobile healthcare reimbursement landscape. Together, we’ve laid down a framework that I believe will lead to significant improvements, ensuring that millions more Americans are fully covered during some of the most critical moments of their lives.
As we present our final findings, I hope that the recommendations will be met with thoughtful consideration by Congress and regulators—the well-being of our patients and the integrity of our out-of-hospital healthcare system depend on it. Thank you to American Ambulance Association President Strozyk, the AAA board and committee chairs, and you, the AAA membership, for the overwhelming support through this journey. Together, we will continue to advocate for a sustainable future for EMS!
Shawn Baird
Immediate Past President
American Ambulance Association
The AAA is projecting that the 2025 Medicare Ambulance Inflation Factor will likely be 2.6%, plus or minus 0.1%.
Section 1834(l)(3)(B) of the Social Security Act mandates that the Medicare Ambulance Fee Schedule be updated each year to reflect inflation. This update is referred to as the “Ambulance Inflation Factor” or “AIF”.
The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year. Starting in calendar year 2011, the change in the CPI-U is now reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi factor productivity index (MFP). The MFP reduction may result in a negative AIF for any calendar year. The resulting AIF is then added to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule.
For the 12-month period ending in June 2024, the federal Bureau of Labor Statistics (BLS) has calculated that the CPI-U has increased by 3.0%.
CMS has yet to release its estimate for the MFP for calendar year 2024. Since its inception, this number has fluctuated between 0.3% and 1.2%. For calendar year 2024, the MFP was 0.4%.
Under normal circumstances, it would be reasonable to expect the 2025 MFP to be within a tenth of a percentage point or two of the 2024 MFP.
Accordingly, the AAA is projecting that the 2025 Ambulance Inflation Factor will likely be 2.6%, plus or minus 0.1%.
The AAA will notify members once CMS issues a transmittal setting forth the official 2025 Ambulance Inflation Factor.
The EMS community is increasingly tasked with responding to behavioral health emergencies. The 988 suicide and crisis lifeline and the emergence of dedicated behavioral health response teams have enhanced support for those in crisis, but also present unique challenges in building impactful, sustainable collaborations.
Hosted by Coalition Psychiatric Emergencies, APHA Medical Care Section, National Association of EMS Physicians and American College of Emergency Physicians, join your EMS colleagues for this important virtual symposium to help your EMS agency prepare for behavioral health emergencies.
Responding to Behavioral Health Emergencies
August 2, 2024
10 am – 4 pm ET
This free symposium will examine the call, the response and the destination for behavioral health emergencies and explore lessons learned regarding 988 and dedicated behavioral health response teams.
Key Topics Include:
988 Suicide and Crisis Lifeline: Learn how it supports those in crisis, including what help is available and how the EMS community can promote 988 for accessing care.
Behavioral Health Response Teams: Discover their success factors and differences from traditional EMS responses.
De-escalation Techniques: Understand the process of managing behavioral health crises and removing individuals from the scene.
Emergency Room Treatment: Explore treatment options, barriers to care, and assessments for ER versus dedicated behavioral health facilities.
Don’t miss this unique opportunity to help your agency prepare for behavioral health emergencies.
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It is essential to understand that EMS directly bills patients instead of insurers only as a last resort. Sadly, as a frequent entry point to healthcare, EMS often faces the unenviable task of educating people about their limited insurance coverage or high deductibles, both of which are out of our control. As mobile healthcare is entirely decentralized in the United States, it is often unfeasible for small or volunteer-staffed ambulance services to negotiate sustainable in-network rates with dozens of insurance plans. The GAPB Advisory Committee’s recommendations seek to remedy this foundational disconnect between patients, EMS providers, and health plans.
The article notes that some EMS providers are owned by private equity, but overlooks that the vast majority of ambulance services in the United States are small, often conducting only a few dozen patient transports per day. These community-based services—some of which are the sole healthcare provider for miles—face skyrocketing costs for wages, fuel, and medical supplies that threaten their ability to keep their doors open. The collaborative work of the GAPB Advisory Committee sought to address these challenges by proposing recommendations that, if adopted by Congress, would help alleviate these financial pressures while also enhancing patient protection from surprise insurance denials.
The article implies that Patricia Kelmar was the only representative of the public interest on the panel. In fact, another Committee participant was explicitly appointed to represent patient advocacy groups, and as healthcare providers, EMS professionals and physicians consistently advocate for our patients’ well-being. The committee’s composition, as established by Congress within the No Surprises Act, was intentionally diverse and included stakeholders ranging from physicians to elected officials to insurance providers to ensure balance.
Additionally, it is important to clarify that the Health Affairs research cited in the article does not provide data on actual balance bills received by patients. Rather, it roughly estimates only potential balance bills as calculated based on a flawed estimation process. Even if we were to accept Health Affairs estimates as fact, the average balance bill calculated according to their methods would be just a few hundred dollars. This is far from the sole and extreme outlier bill cited in the piece. This distinction is critical as it underscores the need for data-driven policy decisions based on real-world evidence rather than projections and one-off examples.
Finally, the piece misses entirely the largest challenge with the Committee’s recommendations and their potential adoption by Congress. Based on longstanding legal precedent, ERISA plans, which cover about half of Americans through their employers, would not be bound by any legislation drafted based on our report. In Washington state and elsewhere, innovative “opt-in” clauses enable ERISA plans to voluntarily comply with state regulation. We encourage this and hope to see it replicated throughout the nation.
People become first responders because they have a passion for caring for others, and our communities trust them to do just that—24/7. Our Committee’s report to Congress includes 14 key recommendations designed to improve transparency, ensure fair reimbursement rates, and ultimately protect patients by strengthening state and local control. If these recommendations are adopted, they will help remove patients from the middle of billing disputes, allowing EMS providers to focus on our primary mission: delivering life-saving and life-sustaining healthcare around the clock.
For a detailed understanding of our recommendations and the Committee’s work, I encourage reading the full GAPB Advisory Committee report when it becomes available later this summer.
Shawn Baird Immediate Past President, American Ambulance Association Member, Advisory Committee on Ground Ambulance and Patient Billing Portland, Oregon
Educating your members of Congress about ambulance industry issues makes them much more likely to support your efforts. An easy and effective way to educate them is to invite them to participate in a local Ambulance Ride-Along!
The House and Senate will be adjourning for summer recess at the end of July and members of Congress will return home to their districts and states. This is the perfect opportunity for you to educate your members of Congress about issues facing our industry, in particular the extension of our Medicare add-on payments, the VA Final Rule, and the EMS workforce shortage, which are important to your operation. For additional information on these issues, visit the AAA Advocacy Page, which includes one pagers about all of our initiatives.
The most effective way to deliver these key messages is to host your member of Congress or their staff on a tour of your operation and an ambulance ride-along. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2024 Congressional Ride-Along Toolkit.
Are you willing to host a Member of Congress at your service but unsure of how to set it up? Email Meghan Winesett at mwinesett@ambulance.org!
Everything you need to arrange the ride-along or schedule a meeting is included in the Toolkit. Act now and invite your elected officials to join you on an Ambulance Ride-Along!
Questions?: Contact Us:
If you have questions about the legislation or regulatory initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.
Additionally, if you are interested in setting up a virtual meeting with your member of Congress please do not hesitate to reach out! We would be happy to schedule the meeting on your behalf and have a member of our advocacy team join the meeting with you.
Tristan North – Senior Vice President of Government Affairs tnorth@ambulance.org
Meghan Winesett– AAA Senior Manager of Government Affairs
mwinesett@ambulance.org
Thank you for your continued membership and support.
