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CMS Proposes to Update ZIP Codes for Ground Ambulance Fee Schedule; Proposed Rule Implements Continuation of the Add-ons and Promises Future Rulemaking on Data Collection

Written by Kathy Lester on . Posted in Government Affairs, Medicaid, Medicare, News.

The Centers for Medicare & Medicaid Servies (CMS) issued the CY 2026 Ambulance Fee Schedule (AFS) proposed rule as part of the annual Physician Fee Schedule rule. It includes three of the American Ambulance Association’s policy priorities germane to the AFS.

First, the Proposed Rule extends the ground ambulance add-ons for urban (2%), rural (3%), and super-rural (22.6%) transports consistent with the statutory mandate. CMS’ Office of the Actuary estimates the extension will provided $260 million over the 10-year budget window to ground ambulance service organizations. CBO had calculated the increase to be $197 million over the same period. 

Second, CMS states that it will address future data collection under the Ground Ambulance Data Collection System (GADCS) in next year’s rulemaking. This recognition of future rounds aligns with the AAA’s ongoing efforts for CMS to continue the data collection, which included securing language in the FY26 appropriations report calling on CMS to continue the program. It is also consistent with our work with MedPAC, which included a  recommendation to continue GADCS in its June 2026 report.

Third, the AAA has been steadfast in its call for CMS to update the geographic designations used to apply the rural and super rural add-on payments. We worked closely with Congressional champions in the House and Senate to echo our request through letters, phone calls, and questions raised during Congressional hearings to administration officials to support the update.

In the Proposed Rule, CMS has finally proposed updating the ZIP codes based on the most recent 2020 U.S. Census and other relevant data. Under the proposal, the vast majority of ZIP codes will remain the same. However,

  • 1,172 ZIP codes would shift from urban to rural; and
  • 602 ZIP codes would shift from rural to urban.

The preamble does not mention ZIP codes shifting to super-rural. CMS indicates that the detailed results will be available on its website at: https://www.cms.gov/medicare/coverage/ambulances-services-center. 

The AAA is reviewing these materials and will provide a detailed analysis with the membership shortly. Based on an analysis by Health Management Associates at the request of the AAA, the latest Census data would result in a net change of 1,490 zip codes changing from rural to super rural – which CMS did not address in the Proposed Rule. Also, HMA had estimated that 119 zip codes would change from rural to urban as opposed to 602 zip codes cited in the document.

In addition to working to ensure the appropriate application of the data to the AFS geographic designations, the AAA will encourage CMS to deem an area designated as a rural or super-rural that would otherwise no longer receive such designation to retain its previous designated status if there are 1,000 or fewer individuals per square mile in the area.  We will also urge CMS to establish an administrative appeals process to allow ambulance services providers and suppliers to seek reconsideration of a change in a ZIP code’s status as a rural or qualified rural area during the first 12 months after the Secretary finalizes a change in the designation.

House Passes 2-Year Ambulance Medicare Relief Extension

Written by Tristan North on . Posted in Government Affairs, Legislative, Medicare, Member Advisories.

The U.S. House of Representatives by a vote of 341 to 88 has passed the Consolidated Appropriations Act for 2026, which would fund the rest of the Federal government for the remainder of FY 2026. Included in the legislative package is an extension for 23 months of the 2% urban, 3% rural, and 22.6% super rural temporary increases in Medicare payments for ground ambulance service organizations. The Senate is scheduled to consider the package next week in time to avoid a partial government shutdown at the end of the month.

The temporary ambulance increases currently run through January 30. Under the package, the increases would be extended through December 31, 2027. Most of the temporary Medicare provider and supplier provisions set to expire would be extended for 11 months through the end of this year. As a result of the efforts of our champions and supporters on Capitol Hill, we were able to secure a longer extension at the same duration of the temporary telehealth provision.

According to an estimate by the Congressional Budget Office, the additional year will provide more than $100 million in relief for a total of $197 million in continued funding to ground ambulance service organizations over the next 23 months.

We will keep you informed as to the Senate consideration of the package.

Senate Cloture on Shutdown Package

Written by AAA Staff on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Member-Only, News, Reimbursement.

The Senate has made progress towards ending the government shutdown. The Senate, by a vote of 60 to 40, invoked cloture on consideration of the House-passed Continuing Resolution after an agreement was reached yesterday with eight Senate Democrats on replacement language, which the Senate will vote on next.

On our specific issues, the language would do the following:
1. Extend the temporary Medicare ambulance add-ons payments through January 30, 2026
2. Prevent PAYGO cuts to Medicare providers and suppliers from H.R. 1
3. Extend Medicare sequestration provider cuts for another month

We will keep you posted on new developments.

Contact your member of Congress today!

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Legislative, Medicare, Member Advisories.

With the Medicare ambulance add-ons having expired at least temporarily, it is critical that you contact your Members of Congress now to ask for their support in reinstating and making permanent this vital financial relief. They can demonstrate their support by cosponsoring the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2232, S. 1643). Please customize the sample template letter to let them know of the financial impact of the loss of the additional 2% urban, 3% rural and 22.6% super rural in additional Medicare payments on your operation.

Click the link below and write your members of Congress today about reinstating and extending the add-on payments.

Contact your members of Congress here!

Congressional Letter on Updating Medicare Zip Codes

Written by Tristan North on . Posted in Advocacy Priorities, Government Affairs, Medicare.

On September 18, Congresswoman Carol Miller (R-WV) was joined by 13 members of Congress in a letter to CMS requesting that the agency update the zip code designations under the Medicare ambulance fee schedule based on the 2020 census.

According to an analysis by AAA data firm of Health Management Associates, the update would result in a net of 1,490 zip codes being redesigned as super rural instead of rural and 782 zip codes being rural instead of urban. Ground ambulance service organizations that serve these rural and super rural areas would thus benefit from the additional reimbursement for rural and super rural areas.

CMS is overdue in automatically updating the zip codes based on the 2020 census data.
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Impact of Potential Federal Government Shutdown on Medicare Payments

Written by Brian Werfel on . Posted in Government Affairs, Medicare, Member Advisories, Reimbursement.

Impact of Potential Federal Government Shutdown on Medicare Payments, Including  the Temporary Aad-ons for Ground Ambulance Services

 

The federal government is funded through annual appropriations enacted by Congress.  Funding for the federal government’s current fiscal year is currently set to expire today, September 30, 2025.  If Congress fails to pass a spending package for the full year – – or a temporary funding package for a shorter period (known as a “continuing resolution”) – – many federal agencies will have to curtail their activities.  On September 18, 2025, the House of Representatives passed a continuing resolution that would have funded the federal government through November 21, 2025; however, that bill failed to pass the Senate.  As a result, barring a last-minute deal, a federal government shutdown will commence on October 1, 2025.

A government shutdown is not expected to impact Medicare payments to health care providers, i.e., Medicare Administrative Contractors will continue to process and pay Medicare claims.  However, past government shutdowns have impacted other Medicare operations, including provider enrollment and pre- and post-payment audit activities.  Providers that are currently in the process of enrolling and/or revalidating their Medicare enrollment may experience delays in the processing of these applications.

As a reminder, existing law requires that Medicare Administrative Contractors hold claims for a minimum of fourteen (14) days.  This “payment floor” would provide a bit of breathing room in the event of a relatively short federal shutdown.  If, however, a shutdown continues for longer than 2 weeks, it is likely that Medicare contractors would be forced to pay ambulance claims with dates of service on or after October 1, 2025 at the statutorily required amount (i.e., an amount that does not take into account the current add-ons).  If the spending deal to reopen the government includes the retroactive extension of those add-ons, the MACs would need to subsequently adjust any payments made at that lower amount.  There is precedent for such retroactive adjustments.  Of course, the current hope is that a deal can be reached early enough to avoid the need for any retroactive adjustments.

Thus, while Medicare payments for ambulance services will continue without interruption, the payment amounts will be impacted.  This is because the temporary add-ons for ground ambulance services (i.e., the 2% urban, 3% rural, and super-rural bonuses) are currently set to expire on September 30, 2025.  The hope is that any deal to avert a shutdown and/or to reopen the government after any potential shutdown will include an extension of these critical add-ons.

The American Ambulance Association is monitoring the situation closely, and will continue to keep our members updated as new information become available.

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